Brugada pattern unmasked during COVID-19 infection -:A case report

Lemes, Carolina; Armaganijan, Luciana; Maria, André Soares; Carvalho, Guilherme Dagostin de; Moussa, Marcel Pereira; Franco, Olívia Shellard Junqueira; Cagi, Rodrigo Caligaris; Dietrich, Cristiano de Oliveira

doi:10.1016/j.jccase.2022.01.003

Cited by 3 publications

(4 citation statements)

References 10 publications

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“… 13 There are several case reports of BrS in acute SARS-CoV-2 infection and thought to be secondary to fever induced by inflammatory response activation. 14 15 SARS-CoV-2 as an unmasking factor was not likely in this patient as she was afebrile throughout her stay without antipyretics, and case reports implicating SARS-CoV-2 and BrS consistently report fever as the unmasking event. 16 This case highlights the importance of recognising genetic disorders, like PHA, that predispose patients to electrolyte derangement and can unmask BrS.…”

Section: Discussionmentioning

confidence: 68%

“…It is therefore important that hyperkalaemia is promptly treated in patients with BrS, as they are highly susceptible to the reduced cardiac excitability effects of hyperkalaemia that can lead to malignant arrythmias and cardiac arrest 13. There are several case reports of BrS in acute SARS-CoV-2 infection and thought to be secondary to fever induced by inflammatory response activation 14 15. SARS-CoV-2 as an unmasking factor was not likely in this patient as she was afebrile throughout her stay without antipyretics, and case reports implicating SARS-CoV-2 and BrS consistently report fever as the unmasking event 16.…”

Section: Discussionmentioning

confidence: 87%

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Brugada syndrome uncovered in patient with pseudohypoaldosteronism due to hyperkalaemia

et al. 2023

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Brugada syndrome is a rare sodium channelopathy that predisposes to an increased risk of malignant arrythmias and sudden cardiac death. Previous studies have reported that metabolic disturbances can uncover a Brugada ECG pattern. Given the risk of malignant arrhythmias, it is important to correctly diagnose and treat Brugada syndrome. We report a case of Brugada syndrome uncovered by hyperkalaemia precipitated in a patient with pseudohypoaldosteronism.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 87%

Brugada syndrome uncovered in patient with pseudohypoaldosteronism due to hyperkalaemia

et al. 2023

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“…Previous case reports of type-I BP in COVID-19 frequently note fever alongside elevated inflammatory markers, a typical severe COVID-19 presentation. However, in one case, no fever, inflammatory marker elevation, or AKI was present, with the authors suggesting a direct role for SARS-Cov-2 in its interaction with the cardiac sodium channel [ 14 ]. At a minimum, fever alone cannot explain this case, and to our knowledge, it is the only published report of type-1 BP in COVID-19 that lacked fever, elevated inflammatory markers (e.g., CRP), and abnormal serum electrolytes.…”

Section: Discussionmentioning

confidence: 99%

“…At a minimum, fever alone cannot explain this case, and to our knowledge, it is the only published report of type-1 BP in COVID-19 that lacked fever, elevated inflammatory markers (e.g., CRP), and abnormal serum electrolytes. Thus, the direct involvement of SARS-Cov-2 with the cardiac sodium channel should still be confirmed [ 9 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

Ventricular Fibrillation in an Afebrile COVID-19 Patient Presenting With Transient Type-I Brugada Pattern

Kreinbrook¹,

Foster²,

Paulino³

et al. 2023

Cureus

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COVID-19 has been associated with an increased risk of both atrial and ventricular arrhythmias. Brugada syndrome (BrS), an inherited sodium channelopathy presenting with a characteristic ECG morphology, confers a baseline risk of ventricular arrhythmias such as ventricular fibrillation (VF), especially during febrile illnesses. However, mimics of BrS, termed Brugada phenocopies (BrP), have been noted in association with fever, electrolyte abnormalities, and toxidromes outside of viral illness. Such presentations manifest the same ECG pattern, the type-I Brugada pattern (type-I BP). Thus, the acute stage of an illness such as COVID-19, when accompanied by a first-time presentation of type-I BP, may not result in a certain diagnosis of BrS versus BrP. Thus, expert recommendations are to anticipate arrhythmia regardless of the presumed diagnosis. Here we demonstrate the importance of these guidelines and a novel report of VF in the setting of a transient type-I BP in afebrile COVID-19. We discuss the potential factors which may have triggered VF, the presentation of isolated "coved" ST elevation in V1, and the difficulty of BrS versus BrP diagnosis in acute illness. In summary, a SARS-CoV-2 positive 65-year-old male without significant cardiac history for BrS presented with type-I BP after two days of shortness of breath. Hypoxemia, hyperkalemia, hyperglycemia, elevated inflammatory markers, and acute kidney injury were present. After treatment, his ECG normalized; however, aborted VF occurred days later while afebrile and normokalemic. Follow-up ECG again revealed a type-I BP, which also became more apparent during an episode of bradycardia, a classic finding in BrS. This case suggests that there is room for larger studies to determine the prevalence and outcomes when type-I BP presents in acute COVID-19. When possible, genetic data should be obtained to confirm BrS, a notable limitation in our case. Regardless, it corroborates guideline-directed clinical management, with heightened vigilance for arrhythmia in such patients until full recovery.

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Brugada syndrome unmasked by dengue fever

Sivanandam,

Basani,

Sanker

et al. 2023

Clinical Case Reports

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Key Clinical MessageUnderstanding the circumstances, leading to unmasking of hidden Brugada syndrome is essential for the practicing clinician and the patients so that they are informed adequately to seek prompt medical attention.AbstractBrugada syndrome is a genetic arrhythmia syndrome characterized by a coved type of ST‐segment elevation in the ECG. The patients are usually asymptomatic, with unmasking of the disease under certain conditions. We are reporting the case of a patient diagnosed with Brugada syndrome, which was unmasked during an attack of dengue fever.

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Brugada pattern unmasked during COVID-19 infection -:A case report

Cited by 3 publications

References 10 publications

Brugada syndrome uncovered in patient with pseudohypoaldosteronism due to hyperkalaemia

Brugada syndrome uncovered in patient with pseudohypoaldosteronism due to hyperkalaemia

Ventricular Fibrillation in an Afebrile COVID-19 Patient Presenting With Transient Type-I Brugada Pattern

Brugada syndrome unmasked by dengue fever

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