Turner Kiera Brigh, Iyyani Murali, Garcia Fernandez Joel A, Carlan Stephen J
Department of Internal Medicine, Orlando Regional Medical Center, Orlando, FL, USA.
Orlando Health Heart Institute, Orlando Regional Medical Center, Orlando, FL, USA.
Am J Case Rep. 2025 May 14;26:e948042. doi: 10.12659/AJCR.948042.
BACKGROUND Brugada syndrome is a hereditary condition characterized by sudden cardiac death or electrocardiogram (EKG)-documented ventricular arrhythmias or arrhythmia-related symptoms in patients without structural cardiac pathology. Brugada phenocopy is a condition with EKG changes consistent with Brugada syndrome, without any hereditary cause. SARS-CoV-2 is a respiratory virus associated with many cardiovascular complications, one of which is new-onset arrhythmia, including Brugada phenocopy or the unmasking of the Brugada syndrome. PPublished cases have revealed the emergence of Brugada pattern among patients with afebrile SARS-CoV-2 infection, suggesting a link with the virus itself and not simply fever. Treatment for Brugada syndrome and Brugada phenocopy involves avoidance of modulating factors that can generate recurrent Brugada patterns. Additional therapy for Brugada syndrome may include implantable cardioverter-defibrillator (ICD) placement, but this treatment was considered unnecessary for a Brugada phenocopy and too risky for a nonagenarian man. Asymptomatic Brugada phenocopy in a COVID-19 patient requires close observation to manage. CASE REPORT A nonagenarian man with SARS-CoV-2 infection presented with chest pain, mild fever, and a Brugada pattern on EKG. He was treated with steroids, remdesivir, and antipyretics, before his Brugada phenocopy resolved. CONCLUSIONS Brugada phenocopy is characterized by fluctuating ST elevations triggered by modulating factors, including electrolyte derangements, fever, infection, and various medications or drugs. Prompt management of Brugada phenocopy is necessary to avoid the development of malignant arrhythmias or sudden cardiac death. Differentiation of Brugada phenocopy and Brugada syndrome is essential to avoid unnecessary ICD placement for Brugada phenocopy.
布加综合征是一种遗传性疾病，其特征为在无结构性心脏病变的患者中发生心源性猝死、心电图（EKG）记录的室性心律失常或心律失常相关症状。布加综合征拟表型是一种心电图改变与布加综合征一致但无任何遗传病因的情况。严重急性呼吸综合征冠状病毒2（SARS-CoV-2）是一种与多种心血管并发症相关的呼吸道病毒，其中之一是新发心律失常，包括布加综合征拟表型或布加综合征的暴露。已发表的病例显示，无发热的SARS-CoV-2感染患者中出现了布加图形，提示与病毒本身有关，而非单纯发热。布加综合征和布加综合征拟表型的治疗包括避免使用可引发反复布加图形的调节因素。布加综合征的额外治疗可能包括植入式心律转复除颤器（ICD）植入，但对于布加综合征拟表型，这种治疗被认为不必要，而对于一名九旬男性来说风险太大。COVID-19患者的无症状布加综合征拟表型需要密切观察以进行管理。病例报告：一名感染SARS-CoV-2的九旬男性出现胸痛、低热，心电图显示布加图形。在其布加综合征拟表型消失之前，他接受了类固醇、瑞德西韦和退烧药治疗。结论：布加综合征拟表型的特征是由调节因素触发的ST段抬高波动，这些调节因素包括电解质紊乱、发热、感染以及各种药物。及时处理布加综合征拟表型对于避免恶性心律失常或心源性猝死的发生至关重要。区分布加综合征拟表型和布加综合征对于避免因布加综合征拟表型而不必要地植入ICD至关重要。
