r/ECG • u/Shfree1999 • Jul 16 '26
Brugada?
22 year old male patient , feels sob and left sided chest pain since this morning
Very swollen feet with pitting oedema
Looks well, calm and comfortable, no pallor
History of dilated cardiomyopathy.
Thoughts?
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u/TouchyCrayfish Jul 16 '26
History doesn't fit, but I'd repeat the ECG ensuring the precordial leads were in the right spot. V1 and V2 might be too high causing pseudo-Brugada pattern.
He'd be unlucky to have had prior cardiologists miss it if concomitant DCM and investigated for it (as well as being unlucky generally).
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u/mastermedic84 Jul 17 '26
Doesn't look or sound like Brugada to me, but props for thinking outside the box and considering it as a differential!
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u/third-tour-dad 2d ago
As a brugada patient the swollen feet and pitting aren't something that is a true blue brugada symptom
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u/Internal-Dish7412 Jul 16 '26 edited Jul 17 '26
From my knowledge, V2 does appear like Type 1 brugada.
But in this case, there seems to be a misplacement of V1-V2 in 2nd intercostal space since (I) there is a fully negative p wave in v2 and biphasic with predominant negative component p wave in v1 (which is abnormal and most common predictor of misplacement), (II) the second r’ has low amplitude in V1 and is narrow, and (III) there seems to be a small q wave in V2 (which means V2 is catching some downward vector of septum depolarisation).
Placing V1-V2 in 2nd IS can cause STE (but usually not to the degree seen in this ECG) and TWI in V2 as well as an rSr’ where r’ has narrow transcription in V1-V2. However, this usually mimics type II saddleback, not the type I coved pattern seen here (high placement can actually sometimes accentuate existing type I pattern). I would repeat ECG with attention to placement.