Type 2 and 3 are not diagnostic of the BrS. Type 3 has either a saddleback or coved appearance with a ST-segment elevation of <1mm (figure 1). The type 2 ST-segment elevation has a saddleback appearance with a high takeoff ST-segment elevation of ≥ 2mm, a trough displaying ≥1mm, and then either a positive or a biphasic T wave. This specific ECG hallmark typically fluctuates over time, and can also be presented as a type 2 or type 3 ECG or even a normal ECG. It is referred to as a coved type Brugada ECG, or type 1 ECG, and cannot be explained by electrolyte disturbances, ischemia or structural heart disease. The ECG in Brugada syndrome is characterized by ST-segment elevations directly followed by a negative T-wave in the right precordial leads (V1-V3) and in leads positioned one or two intercostal space higher. However, most patients with Brugada syndrome are asymptomatic and are under medical attention because of family screening for sudden cardiac death/Brugada syndrome or because a Brugada ECG was found coincidentally.
Other clinical presentations of Brugada syndrome may include sudden infant death syndrome (SIDS) and sudden unexpected nocturnal death syndrome (SUDS), which is seen in southeast Asia in which young persons die from cardiac arrest with no identifiable cause (also known as bangungut in the Philippines, lai tai in Thailand, pokkuri in Japan and dab tsog in Laos. Syncope, pre-syncope (weakness, lightheadedness, dizziness).Patients can present with symptoms of arrhythmias: Inducibility of VT/VF during programmed electrical stimulation A family history of sudden cardiac death <45yrs Self-terminating polymorphic ventricular tachycardia The clinical diagnosis of Brugada syndrome is confirmed in an individual with the following: The prevalence varies between 5-50:10.000, largely depending on the geographic location (especially in some Southeast Asian countries the disease is more prevalent).The right ventricle is most affected in Brugada syndrome, and particularly (but not specifically) the right ventricular outflow tract.The arrhythmias typically occur in patients between 30-40 years of age and often during rest or while sleeping.Males are often more symptomatic than females, probably by the influence of sex hormones on cardiac arrhythmias and/or ion channels.It is an inheritable cardiac arrhythmia syndrome with an autosomal dominant inheritance.The diagnosis is based on ECG findings.
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