![]() ![]() Hospital CourseĤ3-year-old male presented with profound leg weakness, acute renal failure, severe hyperkalemia, rhabdomyolysis, and compartment syndrome. Transthoracic echocardiography (TTE) showed normal systolic and diastolic function with no valvular abnormality.ĮCG on presentation showing ≥2 mm “coved type” ST elevation and a T-wave inversion in precordial leads V1 and V2 (type 1 Brugada pattern). ![]() His EKG was consistent with type 1 Brugada pattern on presentation (Figure 1). MRI thoracolumbar spine did not show any spinal cord abnormality. Urinalysis was significant for +3 blood with 5–9 RBC and +2 proteinuria urine specific gravity was 1.009. His laboratory data showed potassium of 8.2 mEq/L (3.5–5 mEq/L) on nonhemolysed sample. His lower extremities showed black gangrenous area on right calf that was swollen and tense. Heart exam showed regular normal first and second heart sounds with no murmur. There was no back tenderness or deformity. His power on both lower extremities was 0/5 with decreased touch sensation. He was awake and alert and well oriented to time and place. Physical examination showed vitals of blood pressure of 80/57 mmHg, heart rate of 88/minute, respiratory rate of 18/minute, oxygen saturation of 96% on 2 liters of supplemental oxygen through nasal cannula, and temperature of 97☏. He smoked 1 pack/day for 20 years and used cocaine and heroin. Family history was negative for sudden cardiac death or cardiac problem. He denied any history of syncope in the past. Past medical history included seizure disorder and splenectomy due to motor vehicle accident. Review of system was positive for decreased sensation in lower extremities. Case SummaryĪ 43-year-old white male presented to ER with profound lower extremities weakness and severe muscle aches. Here we are presenting a case report of Brugada pattern on ECG caused by hyperkalemia that was reversed with the reversal of electrolyte imbalance. It can also rarely cause Brugada pattern on ECG and it is very important for the clinicians to be aware of this presentation as treatment for both modalities is totally different, needing correction of potassium balance in hyperkalemia induced Brugada pattern and lot of investigations and ICD consideration in Brugada syndrome. Hyperkalemia is one of the most common electrolyte abnormalities that caused vast majority of ECG manifestation ranging from ST elevation to sine waves. We are adding a case to the limited literature about hyperkalemia induced reversible Brugada pattern ECG changes. Since it is very commonly encountered disorder, physicians need to be aware of even its rare ECG manifestations, which include ST segment elevation and Brugada pattern ECG (BrP). Most common ECG findings include peaked tall T waves with short PR interval and wide QRS complex. Severe hyperkalemia can even cause life threatening ventricular arrhythmias and cardiac conduction abnormalities. Hyperkalemia is well known to cause a wide variety of ECG manifestations. Clinical differentiation and recognition are essential for guiding the legitimate action. Various electrolyte disturbances and ion channels blocking drugs could also provoke BrS ECG findings without genetic BrS. Brugada syndrome (BrS) is an inherited disorder of cardiac ion channels characterized by peculiar ECG findings predisposing individuals to ventricular arrhythmias, syncope, and sudden cardiac death (SCD).
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