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Emergency Medicine News:
doi: 10.1097/01.EEM.0000436453.84621.c4
Spontaneous Circulation

Spontaneous Circulation: Take Me Out to the Ballgame

Bruen, Charles MD

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Dr. Bruen is a fellow in critical care medicine and emergency cardiology at Hennepin County Medical Center in Minneapolis. He has special interest in stabilization, resuscitation, hemodynamic evaluation, and emergency cardiovascular care.

A 31-year-old man presented to the ED with syncope. He was previously healthy, takes no medications, and had run a marathon the day before. He was riding the light rail home from a baseball game when he developed vague 4/10 epigastric abdominal pain associated with nausea and diaphoresis. He remembers feeling lightheaded and flushed before momentarily passing out.

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His wife said he became quite pale immediately beforehand. He did not have any headache, chest pain, or shortness of breath before or after the syncopal episode. He has a significant family history of premature coronary artery disease. He had normal vital signs and a normal physical exam in the ED. A 12-lead electrocardiogram was obtained.

The ECG shows sinus rhythm with rSR' pattern in V1 and V2 with borderline prolonged QRS suggestive of incomplete right bundle branch block. Diffuse ST-segment elevation in the precordial leads is suggestive of possible early repolarization or injury pattern. His initial cardiac troponin I was minimally elevated at 0.058 ng/mL. He underwent emergent coronary angiography, which showed normal coronary arteries without significant atherosclerotic changes. His ECG demonstrates a Type 2 Brugada pattern (saddleback ST-T wave with > 2 mm ST-elevation), which suggests Brugada syndrome, a cause of cardiac syncope in those without structural heart disease.

Find a complete case discussion and more information on the evaluation of syncope and Brugada syndrome by reading Spontaneous Circulation in EMN's iPad App on Oct. 7 or in the Spontaneous Circulation blog at http://bit.ly/EMNblogPage on Oct. 13, where additional EKGs are also available.

Click and Connect! Access the links in EMN by reading this issue on our website or in our iPad app, both available on www.EM-News.com.

© 2013 by Lippincott Williams & Wilkins

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