Teachable Moments - Cardiology

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The pericardium is electrically silent, and so true acute pericarditis should not be associated with ECG changes. STE actually implies concurrent involvement of the myocardium; i.e. myopericarditis. The greater the degree of myocardium involved, the more ECG changes will develop, including STE, AV blocks, and dysrhythmias. Additionally, myocardial involvement is implied by elevated troponin levels, the magnitude of which is related to the amount of myocardial involvement.

[Imazio M, Trinchero R. Myopericarditis: etiology, management, and prognosis. Int J Cardiol 2008;127:17-26.]

Brugada Syndrome

Brugada syndrome:
1. Coved or saddle-shaped ST-segment elevation in leads V1 through V3 on ECG.
2. Associated with complete or incomplete right bundle-branch block and T-wave inversion.
3, Patients with Brugada syndrome are prone to develop ventricular tachyarrhythmias, which may lead to syncope, cardiac arrest, or sudden cardiac death.
4. Brugada syndrome is genetically determined and has an autosomal dominant pattern of transmission in about 50% of familial cases.
5. About 5% of survivors of cardiac arrest have no clinically identified cardiac abnormality; about half of these cases are thought to be due to Brugada syndrome.
6.. Because of its recent identification, the incidence of the Brugada syndrome is not well established. It may cause 4-10 sudden deaths per 10,000 population per year.
7. In Asia (eg, the Philippines, Thailand, Japan), Brugada syndrome seems to be the most common cause of natural death in men younger than 50 years. It is known as Lai Tai (Thailand), Bangungut (Philippines), and Pokkuri (Japan). In Northeast Thailand, the mortality rate from Lai Tai is approximately 30 per 100,000 population per year (Nademanee, 1997).

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