Ching C K, Teo W S
Department of Cardiology, National Heart Centre, Mistri Wing, Third Hospital Avenue, Singapore 168752.
Singapore Med J. 2004 Nov;45(11):538-40; quiz 541.
A 46-year-old man complained of recurrent episodes of giddiness which was not associated with chest pain or breathlessness. There was no family history of sudden death. Clinical examination was unremarkable.12-lead electrocardiogram (ECG) showed ST segment elevation in the right precordial leads, with coved ST segment elevation at its J point followed by a negative T wave with no isoelectric separation, specifically in V2. These ECG features are characteristic of the Brugada syndrome. He underwent a flecanide challenge which produced further elevation of ST segment at its J point and spontaneous ventricular ectopy. Electrophysiological studies induced ventricular fibrillation with 3 extra stimuli. An implantable cardioverter-defibrillator was implanted for prevention of sudden cardiac death. The Brugada syndrome is discussed.
一名46岁男性主诉反复出现头晕发作，与胸痛或呼吸急促无关。无猝死家族史。临床检查无异常。12导联心电图（ECG）显示右胸前导联ST段抬高，J点处ST段呈穹窿样抬高，随后T波倒置且无等电位线分离，特别是在V2导联。这些心电图特征是Brugada综合征的典型表现。他接受了氟卡尼激发试验，结果J点处ST段进一步抬高并出现自发性室性早搏。电生理研究通过3次额外刺激诱发了室颤。植入了植入式心脏复律除颤器以预防心源性猝死。文中对Brugada综合征进行了讨论。
