EKG OF THE WEEK1/22/2014

BRUGADA PATTERNS

http://thetornosnetwork.blogspot.com/2011/05/brugada-syndrome.html

Brugada Syndrome

• Brugada pattern plus on or more criteria: a) Documented ventricular fibrillation b) Self-terminating polymorphic VT c) Family history of sudden cardiac death at <45 years d) Type 1 ST segment elevation in family members e) Electrophysiologic inducibility of VT f) Unexplained syncope suggestive of a tachyarrhythmia g) Nocturnal agonal respiration

RIGHT BUNDLE BRANCH BLOCK

LAST WEEK:44 YEAR OLD MAN WITH HISTORY OF ALCOHOL ABUSE

OSBORNE WAVES

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• Slows all conduction (RR, PR, QRS, QT)• Osborne Wave height relates to degree of hypothermia

(classically most prominent in leads V2 to V5)• Resuscitation is not terminated until core reaches 32-35

degrees

Take Home Points:• General:

• Abnormal QRS in V1 (also V2, V3)• Prolonged QRS and R-prime, can represent RBBB or

Brugada• Osborne waves represent slowed conduction but not the

bundle branch block of RBBB or repolarization abnormality of Brugada

• This ECG: • Appears to be Brugada type I

• Non-saddleback• Most concerning of Brugada patterns