A STEMI mimic (Brugada ECG pattern) unveiled by influenza fever

Abstract

Brugada syndrome is a genetic disease with a characteristic electrocardiogram (ECG) findings of ST elevation in leads V1-V3 with a right bundle branch block (RBBB) appearance called Brugada ECG pattern and a tendency to develop malignant polymorphic ventricular arrhythmias that may lead to syncope or cardiac arrest. Common triggers for Brugada ECG pattern include fever, tricyclic antidepressants, lithium, cocaine and alcohol. This ECG pattern together with clinical findings mentioned above is termed Brugada Syndrome. We report a case of a 51-year-old male with a past medical history of hypertension presented to emergency department with 2-day complaint of fever, chills, sore throat, nasal congestion, malaise, productive cough, was positive for Influenza B and on ECG found to have type-I (coved) Brugada ECG pattern. Influenza fever associated with Brugada ECG pattern is a rare manifestation; in fact, to the best of our knowledge, only three case reports have been published in the literature to date.

Cardiac Arrest Due to Brugada Syndrome Associated With Influenza Infection: A Case Report and Literature Review

“…To date, only four case reports have been published in English. The major clinical features described in the four previously reported cases of Brugada-like ECG changes and our case are summarized in Table 1 [ 2 , 4 - 6 ].…”

“…However, treatment for asymptomatic patients with a Brugada ECG pattern but no history of syncope, arrhythmia, or family history of cardiac death has not been established. Electrophysiological studies in these patients may be beneficial to evaluate risk [ 4 , 6 ].…”

“…Fever is recognized to induce the Brugada electrocardiographic (ECG) pattern; other known risk factors include sodium channel blockers, tricyclic antidepressants, anesthetics, cocaine, methadone, antihistamines, and electrolyte imbalances [ 3 ]. To date, there have been only four cases of Brugada-like ECG changes associated with fever related to influenza infection reported in the English literature, according to the PubMed database [ 2 , 4 - 6 ]. To our knowledge, however, the case presented herein is the first of cardiac arrest due to the Brugada syndrome associated with influenza infection.…”