Brugada pattern masking anterior myocardial infarction

Seow SC, Omar AR, Hong ECT
Correspondence: Dr Seow Swee Chong, swee_chong_seow@nuhs.edu.sg

ABSTRACT
A middle-aged male smoker presented with atypical chest pain. Initial electrocardiogram (ECG) showed Brugada Type 1 pattern. Subsequent ECGs demonstrated evolving anterior ST elevation myocardial infarction (STEMI), consistent with the elevated cardiac enzymes. Coronary angiogram showed significant stenoses in the left anterior descending artery, which were stented emergently. In retrospect, subtle changes were noted in the initial ECG, which could have alerted one to the STEMI. However, the presence of a Brugada Type 1 pattern masked the ECG changes of anterior STEMI and made the diagnosis difficult. A discussion of the literature surrounding Brugada syndrome is undertaken, including its clinical features, risk stratification and management.

Keywords: Brugada syndrome, electrocardiogram, myocardial infarction, ST elevation
Singapore Med J 2011; 52(9): 647–651