Relation of the Brugada Phenocopy to Hyperkalemia (from the International Registry on Brugada Phenocopy)

Xu, Grace; Gottschalk, Byron H.; Anselm, Daniel D.; Benditt, David G.; Maheshwari, Ankit; Sreenivasan, Shiva; Shama, Raed Abu; Dendramis, Gregory; Barajas-Martínez, Héctor; Campal, J.M. Rubio; Aznaurov, Sam G.; Baranchuk, Adrián

doi:10.1016/j.amjcard.2017.12.008

Cited by 22 publications

(16 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The Brugada phenocopy has occurred in the setting of severe hyperkalemia typically with a potassium >6.5 mmol/L with an average potassium of 7.45 ± 0.89 mmol/L. 5 , 6 In cases of hyperkalemia‐induced Brugada phenocopy, the high extracellular potassium potentially inactivates cardiac sodium channels by decreasing the resting membrane potential, thus resulting in the outward potassium current dominating. 6 This negative hyperkalemic effect causes delayed depolarization resulting in ST‐segment elevation in the anteroseptal region of the ECG with the Brugada type 1 pattern predominantly.…”

Section: Discussionmentioning

confidence: 99%

Brugada phenocopy secondary to hyperkalemia and hyponatremia in primary adrenal insufficiency

2022

View full text Add to dashboard Cite

Introduction The Brugada phenocopy represents electrocardiogram (ECG) changes nearly identical to the Brugada syndrome but without the congenital abnormality associated with lethal arrhythmias and normalizes with treatment of the underlying etiology. This case highlights the Brugada phenocopy in the setting of moderate hyperkalemia and severe hyponatremia from adrenal insufficiency that resolves with treatment of the underlying metabolic disturbance. Case Report A 26‐year‐old man with no prior medical history presented to the emergency department with syncope, and his ECG revealed a Brugada‐like pattern. The patient was found to have significant metabolic derangements, including severe hyponatremia (94 mEq/L), moderate hyperkalemia (6.1 mEq/L), severe hypochloremia (<60 mEq/L), acute kidney injury, and rhabdomyolysis. The patient was diagnosed with primary adrenal insufficiency, and electrolyte correction led to resolution of the Brugada phenocopy. Conclusion The Brugada phenocopy on ECG can occur with severe hyponatremia and moderate hyperkalemia and quickly resolves with electrolyte correction.

show abstract

Section: Discussionmentioning

confidence: 99%

Brugada phenocopy secondary to hyperkalemia and hyponatremia in primary adrenal insufficiency

2022

View full text Add to dashboard Cite

show abstract

“…The literature is not replete with describing the manifestation of BrP ECG pattern in the presence of severe hyponatremia, and currently there are only a few case reports and series that discuss this possible association5,7,8,26 Mechanistically, it is suspected that severe hyponatremia has a similar potential to diminish the electrochemical ionic gradient, by decreasing the inward sodium current and leaving the transient outward current unopposed. This may result in the loss of the action potential dome in the right ventricular epicardium producing a Brugada phenocopy 27.…”

Section: Discussionmentioning

confidence: 99%

“…In a study by Xu et al, two cases (7%) displayed BrP with hyponatremia also with a myriad of electrolyte derangements such as acidosis, hyperkalemia, hypocalcemia, hyperphosphatemia, and hyperglycemia. In seven cases (26%), provocative testing using sodium channel blockers was performed, and all failed to reproduce a BrS ECG pattern (BrP class A) 7. Additionally, no SCD or malignant VAs were detected 7,28…”

Section: Discussionmentioning

confidence: 99%

“…In seven cases (26%), provocative testing using sodium channel blockers was performed, and all failed to reproduce a BrS ECG pattern (BrP class A) 7. Additionally, no SCD or malignant VAs were detected 7,28…”

Section: Discussionmentioning

confidence: 99%

“…Currently, there is a paucity of literature with respect to the Brugada-type ECG pattern that is observed in patients with electrolyte disturbances, specifically hyponatremia 7–9. This case highlights a highly suspicious severe hyponatremia-induced Brugada type 1 ECG phenocopic pattern, which subsequently normalized following resolution of the electrolyte derangement.…”

Section: Introductionmentioning

confidence: 87%

See 2 more Smart Citations

<p>Suspected hyponatremia-induced Brugada phenocopy</p>

Ramsaroop¹,

Seecheran²,

Seecheran³

et al. 2019

IMCRJ

View full text Add to dashboard Cite

Brugada syndrome is a genetic condition that predisposes to an increased risk of ventricular fibrillation and sudden cardiac death in a structurally normal heart. The Brugada type 1 electrocardiogram (ECG) pattern may occur independently of the actual syndrome, and this clinical phenomenon is often referred to as Brugada phenocopy. There are several other factors which have been known to induce this electrocardiographic pattern, and currently, there is a paucity of literature with respect to the pattern that is observed in patients with electrolyte disturbances, specifically hyponatremia. This case report highlights a suspected hyponatremia-induced Brugada type 1 ECG pattern, which subsequently normalized following resolution of the electrolyte derangement.

show abstract

Multifactorial Brugada Phenocopy

2018

Self Cite

View full text Add to dashboard Cite

Multifactorial Brugada PhenocopyTo the Editor We read with interest the article by Heckle et al 1 recently published in the Challenges in Clinical Electrocardiography section of JAMA Internal Medicine. The authors addressed the case of a woman in her 50s who presented with altered mental status and respiratory distress requiring intubation in the field. An electrocardiogram (ECG) was recorded on presentation, which was interpreted by the authors as a normal sinus rhythm with a right bundle branch pattern and loss of P-wave amplitude in the precordial leads. It was pointed out that the most profound ECG abnormality was the greater than 5-mm coved-type ST-segment elevation in leads V 1 to V 2 with the presence of Q waves. After decreasing the potassium level, the ECG no longer presented segment elevation in leads V 1 to V 2 .The authors attributed the ST-segment changes to hyperkalemia in the setting of rhabdomyolysis, acute renal failure, acidosis, and angiotensin-converting enzyme inhibitor use. In our opinion, the ECG showed in leads V 1 to V 2 a typical Brugada type-1 pattern with 2 mm or more coved ST-segment elevation followed by a negative T-wave. Considering this, it would have been desirable to perform, once hyperkalemia resolved, a provocative challenge with a sodium channel blocker. If negative, the diagnosis to consider is Brugada phenocopy. 2 Brugada phenocopies are clinical entities with identical electrocardiographic patterns as true congenital Brugada syndrome, but caused by various clinical circumstances. There are several factors that we would like to discuss and that could have played an important role in the development of this pattern.Hyperkalemia, among others, has been identified as a metabolic condition that can reproduce the BS pattern by decreasing the resting membrane potential, which determines an inactivation of the sodium channels. This produces an imbalance between the entrance of sodium to the cell and the exit of potassium with predominance of the latter which is more pronounced in the right ventricle and more active in the epicardial cells than in the endocardium and in the M cells. 3 Another factor that was not taken into account by the authors was the intake of amitriptyline. This tricyclic antidepressant can reproduce the Brugada ECG pattern both in clinical practice and in experimental models. 4 On the other hand, it is well known that cocaine blocks the sodium channels and therefore could have some role in unmasking true Brugada syndrome.

show abstract

Relation of the Brugada Phenocopy to Hyperkalemia (from the International Registry on Brugada Phenocopy)

Cited by 22 publications

References 13 publications

Brugada phenocopy secondary to hyperkalemia and hyponatremia in primary adrenal insufficiency

Brugada phenocopy secondary to hyperkalemia and hyponatremia in primary adrenal insufficiency

<p>Suspected hyponatremia-induced Brugada phenocopy</p>

Multifactorial Brugada Phenocopy

Contact Info

Product

Resources

About