Brugada Pattern in Diabetic Ketoacidosis: A Case Report and Scoping Study

Haseeb, Syed; Kariyanna, Pramod Theetha; Jayarangaiah, Apoorva; Thirunavukkarasu, Ganesh Keshav; Hegde, Sudhanva; Marmur, Jonathan D.; Neurgaonkar, Sneha; McFarlane, Samy I.

doi:10.12691/ajmcr-6-9-2

Cited by 20 publications

(7 citation statements)

References 47 publications

(44 reference statements)

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“…Ion channel dysfunction has been associated with diabetes mellitus (DM), leading to the development of a heart disorder called diabetic cardiomyopathy (179,180), characterized by contractile dysfunction, abnormal cardiac electrical activity, mitochondrial dysfunction, arrhythmia, and sudden cardiac death (159,160). Several patients affected by DM have been reported to exhibit the BrS ECG pattern, whether it was considered "true BrS" or a "BrS phenocopy" (104,(181)(182)(183)(184), although a difference between "true BrS" and "BrS phenocopy" may not actually exist (41). A case report described a 16-yearold boy affected by DM and a mutation in the GPD1L gene who died suddenly during the night (185).…”

Section: Brugada Syndrome and Diabetesmentioning

confidence: 99%

Brugada Syndrome: Warning of a Systemic Condition?

D'Imperio

Monasky

Micaglio

et al. 2021

Front. Cardiovasc. Med.

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Brugada syndrome (BrS) is a hereditary disorder, characterized by a specific electrocardiogram pattern and highly related to an increased risk of sudden cardiac death. BrS has been associated with other cardiac and non-cardiac pathologies, probably because of protein expression shared by the heart and other tissue types. In fact, the most commonly found mutated gene in BrS, SCN5A, is expressed throughout nearly the entire body. Consistent with this, large meals and alcohol consumption can trigger arrhythmic events in patients with BrS, suggesting a role for organs involved in the digestive and metabolic pathways. Ajmaline, a drug used to diagnose BrS, can have side effects on non-cardiac tissues, such as the liver, further supporting the idea of a role for organs involved in the digestive and metabolic pathways in BrS. The BrS electrocardiogram (ECG) sign has been associated with neural, digestive, and metabolic pathways, and potential biomarkers for BrS have been found in the serum or plasma. Here, we review the known associations between BrS and various organ systems, and demonstrate support for the hypothesis that BrS is not only a cardiac disorder, but rather a systemic one that affects virtually the whole body. Any time that the BrS ECG sign is found, it should be considered not a single disease, but rather the final step in any number of pathways that ultimately threaten the patient's life. A multi-omics approach would be appropriate to study this syndrome, including genetics, epigenomics, transcriptomics, proteomics, metabolomics, lipidomics, and glycomics, resulting eventually in a biomarker for BrS and the ability to diagnose this syndrome using a minimally invasive blood test, avoiding the risk associated with ajmaline testing.

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Section: Brugada Syndrome and Diabetesmentioning

confidence: 99%

Brugada Syndrome: Warning of a Systemic Condition?

D'Imperio

Monasky

Micaglio

et al. 2021

Front. Cardiovasc. Med.

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“…In this case, severe hyperkalemia and acidosis secondary to diabetic ketoacidosis were likely the precipitating factors causing the BrP findings. The mechanism of BrP in patients with DKA is not fully understood but is proposed to be related to hyperkalemia and acidosis inactivating cardiac sodium ion channels by decreasing the resting membrane potential [ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

Brugada Pattern Manifesting During Hyperkalemia, Diabetic Ketoacidosis, and Acute Alcohol Intoxication

et al. 2021

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Patient: Male, 28-year-old Final Diagnosis: Alcohol intoxication • Brugada pattern • diabetic ketoacidosis • hyperkalemia Symptoms: Encephalopathy Medication:— Clinical Procedure: — Specialty: Cardiology Objective: Rare disease Background: Brugada syndrome is a rare ion channelopathy that can lead to sudden cardiac death and lethal arrhythmias in patients without a structural cardiac defect, the most common of which being the gain-of-function mutation of the SCN5a sodium ion channel involving phase 0 of the cardiac action potential. In 2012, BrS electrocardiogram findings were redefined and classified as either congenital Brugada syndrome (BrS) or Brugada pheno-copies (BrP). Several etiologies of BrP have been reported, such as metabolic derangements, electrolyte abnormalities, cardiovascular diseases, and pulmonary embolism. Case Report: A 28-year-old man presented to the Emergency Department unresponsive. An initial ECG taken by Emergency Medical Services (EMS) was interpreted as a STEMI. An initial ECG in the ED showed a Brugada type I ECG pattern in leads V1-V2 and hyperacute T wave abnormalities, among other findings. Additionally, the patient had a serum potassium level of 9 mmol/L, glucose level of 1375 mmol/L, and peak cardiac troponin-I of 20.452 μg/L. All underlying medical conditions were stabilized, electrolyte and metabolic abnormalities were corrected, and subsequent normalization of electrocardiographic findings was achieved. Conclusions: Distinguishing congenital Brugada syndrome from Brugada phenocopies can be difficult, especially when patients present to the ED with severe underlying conditions. Several factors can be used to direct clinical suspicion towards one or the other; however, confirmation may require EP studies and further tests. In this case, the following findings were suggestive of BrP: presence of an identifiable underlying abnormality, correction of the underlying condition resolves the ECG pattern, and the absence of family history of sudden cardiac death.

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“…The first indication of this connection between blood glucose and cardiac events in Brugada syndrome is a report from the Thai ministry of Public Health in 1990. They found an association between Brugada syndrome patients consuming a large carbohydrate-heavy meal the night they passed away in their sleep [ 8 ]. This association was further investigated in Nogami et al who found the accentuation of ST-segment in high-risk Brugada syndrome patients following infusion of glucose or glucose and insulin solution, even with little to no isoelectric separation between the Brugada syndrome patients and controls [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

A rare case of Brugada syndrome induced by hyperglycemia

et al. 2021

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Brugada syndrome is a rare genetic disorder of the cardiac sodium channels associated with an increased risk of sudden cardiac death. It is characterized by an electrocardiogram (EKG) showing a right bundle branch block with an elevation in the ST segment. This condition is associated with mutations in several pathologic genes including the most notable mutation in the SCN5A gene, which encodes for a voltage-gated cardiac sodium channel. The Brugada pattern on EKG can be spontaneous but can also be induced by a variety of etiologies including fever, electrolyte abnormalities, increased vagal tone and drugs such as sodium channel blockers, calcium channel blockers, tricyclic antidepressants and alcohol. One uncommon cause of Brugada syndrome is hyperglycemia. Of particular importance in diabetic patients, hyperglycemia can induce chronic cardiovascular complications as well as acute cardiac events via the induction of the Brugada pattern on EKG. We present a case of a 21-year-old non-insulin compliant diabetic man presenting to the Emergency Department with diabetic ketoacidosis (DKA) who exhibits the Brugada pattern EKG prior to developing ventricular tachycardia followed by cardiac arrest. The patient’s condition was induced by prolonged hyperglycemia in the setting of DKA with relatively mild electrolyte and pH abnormalities. Herein, this case is presented to highlight the Brugada pattern leading to cardiac arrest as a potential consequence of hyperglycemia and inform physicians on its incidence.

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Brugada Pattern in Diabetic Ketoacidosis: A Case Report and Scoping Study

Cited by 20 publications

References 47 publications

Brugada Syndrome: Warning of a Systemic Condition?

Brugada Syndrome: Warning of a Systemic Condition?

Brugada Pattern Manifesting During Hyperkalemia, Diabetic Ketoacidosis, and Acute Alcohol Intoxication

A rare case of Brugada syndrome induced by hyperglycemia

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