You’re reviewing a 44 year old obese patient whose wife has noticed that he is breathing abnormally at night time.
His ECG is as below:
- Rate: 48
- Rhythm: sinus
- Axis: Normal (0-90)
- Morphology: RSR pattern V1/2, 1mm STD and deep TWI in aVR, 1mm saddleback STE V1 with assoc. +ve-ve TWI, u wave
- Intervals: PR 140, QRS 100, QTC 376 (Bazetts)
- Summary: together with a history of possible nocturnal atonal respirations this is suspicious for Brugada Type 3 (but not diagnostic given saddleback change in one lead only)
Specifically in Brugada
- Nocturnal agonal respiration
- Documented VF or polymorphic VT
- FHx of sudden cardiac death
- Coved ECG change in family members
- Unducible VT under programmed electrical stimulation
Further Reading – Textbook:
Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.