S.P. Mahaley 1, Irnizarifka2, C. Sukmagautama3, H. Arifianto2
1General Practitioner
2Departement of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret, Sebelas Maret University Hospital, Surakarta, Indonesia.
2Departement of Internal Medicine, Sebelas Maret University Hospital, Faculty of Medicine, Universitas Sebelas Maret, Indonesia.
Background: Brugada syndrome, first described in 1992, is a major cause of sudden cardiac death, syncope and ventricular tachyarrhythmia in people with no structural heart disease. Brugada syndrome usually manifests during adulthood, with a mean age of sudden death of 41±15 years old.
Case illustration: 58 years old male was admitted to RS UNS with fatigue for 3 days. Along with other physical and laboratory examinations, patient was diagnosed as having septic shock. As soon as transferred to high care unit, patient was having pulseless ventricular tachycardia but 3 minutes CPR was able to get him back with soporous condition. Laboratory showed severe hyponatremia (128 mEq/l) and baseline ECG evidenced type 1 Brugada. The 3% NaCl was administrated until his sodium level went up to 141 mEq/l. Patient’s condition was improved and brugada pattern ECG was back to normal. Patient was then discharged in good condition without any further cardiac events.
Discussion: Brugada syndrome is characterized electrocardiographically by ST segment elevation in the right precordial leads, followed by a negative T wave unrelated to ischemia, and prone to rapid polymorphic ventricular tachycardia capable of degenerating into ventricular fibrillation. The ECG pattern may be dynamic and is often concealed. Sodium channel blockers, drugs, electrolyte imbalances, fever and several other clinical circumstances are recognized inducers of a Brugada type 1 ECG in susceptible patients.
Conclusion: We have managed temporary but deadly type-1 Brugada Syndrome in septic patient through sodium level improvement. Brugada-induced severe hyponatremia did exist and might be lethal, thus accurate diagnosis must be done to generate definite treatment and convert ECG pattern to normal.
Keyword: brugada induced, severe hyponatremia, ventricular tachycardia
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