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Diffuse Transient Pseudo-Brugada ECG pattern in the setting of a Left Anterior Descending Artery obstruction

Dr. Andrés R. Pérez Riera
Dr. Andrés R. Pérez Riera
Brazil

Case presentation

65-year-old Caucasian male, type2 diabetes, hypertension, smoking since long time ago. He was in regular use of losartan, furosemide, simvastatin, and metformin. He had previous medical history of cerebrovascular accident occurred 1 year ago with sequelae (hemiparesis and aphasia). There was no history of syncope, palpitations, or family history of sudden cardiac death.
He arrived in our Emergency Department (ED) after collapsing suddenly while he was watching TV. He was taken to the Hospital by his relatives, where he entered with FV (Figure 1). After 6 separate defibrillations and 5 min of CPR, the patient had his circulation spontaneously back.

Heart rate of 75 bpm and blood pressure of 154/100 mmHg.
Lab: Normal calcium and magnesium serum levels, cardiac troponin T (cTnT): 0.871, creatinine: 0.87, C-reactive protein (CRP): 3,27mg/L (CRP levels ≥2 mg/L likely need more intense management and treatment for heart disease). .
Serum potassium measured by gasometry = 2.81?
Electrocardiogram (figure 2) revealed broad QRS complexes and bizarre coved-type ST-segment elevation across precordial leads (V1 through V6), I and aVL, followed by negative T wave consistent with anterolateral type 1 Brugada pattern.
Emergent Coronary angiogram showed significant stenosis (80%) with thrombus in the proximal left anterior descending artery, which needed stent emergently. After, percutaneous transluminal coronary angioplasty (PTCA) with insertion of drug-eluting stent in the LAD, diffuse ST- segment elevation was solved and did not recur. In addition, broad QRS disappeared.
Echocardiography showed normal left ventricular ejection fraction and no segmental wall motion abnormality.

Question

Which is the clinical-electrocardiographic diagnosis?

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Auspicios Institucionales
  • Sociedad Argentina de Cardiología
  • Federación Argentina de Cardiología
  • SIAC
  • SADEC
  • Asociación Argentina de Cardiología
  • Latin American Heart Rhythm Society
  • Fundación Barceló - Facultad de Medicina