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Brugada syndrome is characterized electrocardiographically by ST segment elevation in the right precordial leads, followed by a negative T wave unrelated to ischemia, electrolyte disturbance or drug effects 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. We describe a case of a Brugada type 1 ECG pattern induced by severe hyponatremia. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Primary electrical syndromes are a group of rare inherited diseases that predispose to arrhythmias in the absence of structural abnormalities of the heart, and are associated with several ion channel mutations. Extrinsic factors, such as fever, may contribute to the development of electrical instability in these patients. We report the case of a 52-year-old patient who was admitted for syncope and had an in-hospital episode of ventricular fibrillation, who presented with an admission ECG showing marked precordial ST segment elevation (maximum 5 mm in V2). The patient did not have structural heart disease and during the hospital stay there was progressive ST segment normalization, with features suggestive of Brugada pattern. An automated defibrillator was implanted for secondary prevention of sudden cardiac arrest. We believe that these findings may represent a new form of presentation of a genetic electrical syndrome. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objectives: A newly discovered heart syndrome mimicking acute coronary syndrome has been termed ‘Tako-Tsubo cardiomyopathy’ (TTC). Differentiation from acute myocardial infarction using the ECG is an important issue in clinical practice. Methods: We retrospectively analyzed patients admitted for cardiac catheterization between September 2003 and September 2006. Results: From 26,593 cardiac catheterization procedures, we identified 21 patients with suggested TTC (0.08%). Trigger mechanisms were present in 38.1%; all patients had elevated troponin levels (mean 3.9 ng/ml). Median age was 68.4 years; 90.5% were female. Hypertension was seen in 85.7% and atrial fibrillation in 19.1%. Specific ECG findings related to a TTC are: a mild elevation of the ST segment arising from the S curve of the QRS complex, where the maximum ST segment elevation at the basis of the T wave is <1.5 mm, T-wave inversion, absence of ST segment depression and a summated amplitude of the S curve in V1 plus R in V6 <1.5 mV. An intraventricular gradient was seen in 9.5%; coronary atherosclerosis was detected in 57.1%. Follow-Up Data: Mean follow-up was 13.2 months. 47.6% were free from angina or dyspnea, most of the patients received β-blockers/ACE inhibitors (76.2%). One patient had a sudden cardiac death (4.8%), 1 patient became an implantable cardioverter-defibrillator primarily due to resuscitation. Conclusion: TTC is a rare syndrome mimicking acute coronary syndrome that shows a specific ECG pattern and does not appear to be an unambiguously benign disease. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: Attempts to demonstrate preconditioning during repeated angioplasty balloon inflations (BIs) have not been universally successful. The main obstacle is that the first BI is unreliable, due to the variable degrees of occlusion by the deflated balloon. In the present study, we examined whether ST segment elevation decreases and evaluated its relation to collateral recruitment during repeated angioplasty BIs in the pig. Methods and Results: Twenty male pigs, 7 months old, under general anesthesia, underwent 3 repeated BIs of 120 s, with a 5-min interval between them, in the left anterior descending artery or the right coronary artery. A pressure wave wire was used for the measurement of coronary wedge pressure and to obtain the intracoronary ST segment elevation. Intracoronary ST segment elevation was 1.97 ± 0.76 mV during the 1st BI, 2.09 ± 0.82 mV during the 2nd BI and 1.84 ± 0.82 mV during the 3rd BI (p = n.s.). Coronary wedge pressure was 12 ± 6, 18 ± 18 and 20 ± 20 mm Hg (p < 0.05 vs. 1st BI) during the 3 BIs, respectively. Conclusion: Repeated BIs do not diminish ST segment elevation in the pig model, even though coronary collateral recruitment is promoted. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]