Question 6#

A 37-year-old man presents to A&E with pneumonia and a temperature of 39°C. He has no chest pain but a routine ECG is performed.


A. He should be referred for primary angioplasty
B. His temperature may have exacerbated his ECG changes
C. He should be treated with ajmaline
D. He needs an ICD
E. Beta-blockers are indicated

Correct Answer is B


This ECG is highly suggestive of Brugada syndrome with a type 1 pattern, i.e. >2 mm ST elevation in the J point, downsloping ST  elevation, and inverted T waves best seen in lead V2. The ECG changes can certainly be brought about by fevers, and therefore B is the correct answer. There is no description of syncope and therefore the patient does not meet the criteria for considering an ICD. Ajmaline is not a treatment for Brugada! It is a test for people with type 2 or type 3 Brugada pattern on ECG to provoke a type 1 pattern, but should not be given to people who already have a type 1 pattern as it may provoke dangerous arrhythmias. There is no well-established medical therapy for Brugada syndrome although trials with quinidine are under way.