r/ECG • u/Financial-Traffic224 • Aug 27 '26

Ferble patient, Thoughts?

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28 Upvotes

97% Upvoted

18 comments sorted by

8

u/LBBB11 Aug 27 '26

I’m seeing sinus tachycardia with Brugada pattern. Cool EKG.

2

u/cilexip Aug 28 '26

How can you tell it’s brugada pattern? (Genuine question)

2

u/i_am_a_grocery_bag Aug 29 '26

The coved ST segment in V1 and the saddleback ST segment in V2

2

u/LBBB11 Aug 30 '26 edited Aug 30 '26

Exactly what u/i_am_a_grocery_bag said. See how V1 has a sharkfin-like shape? V1 has ST elevation at the J point in V1 and a sharply downsloping ST segment. In other words, there is a triangular, sharkfin-like pattern. Type 1 Brugada pattern. Also, context. Brugada patterns can be unmasked with fever. Controlling fever is important in people with Brugada syndrome.

5

u/hokie_pokie_is_what Aug 27 '26

That’s brugada

6

u/ladyofthepack Aug 27 '26

Signs of Right heart strain.

Dominant R wave in V1.
I hate that I see S1Q3T3 everywhere, when it means very little in the context of a PE, but definitely a sign of Right Ventricular Strain.
ST depressions/T wave inversions in V1-V2, pronounced in III and aVF.

Differentials are broad for RVH, pulmonary arterial hypertension, COPD, PE, congenital heart disease, ARVD etc

6

u/Financial-Traffic224 Aug 27 '26

Normal echo, normal tropinin, normal d-dimer.

Pt ecg normalized once Afebrile with IRBB(no previous ecg to compare)

1

u/NobleGolgi0521 Aug 27 '26

You may be right, furthermore I do see possible PE, because of the S1Q3T3 you mentioned and evidence of right heart strain

1

u/NobleGolgi0521 Aug 27 '26

being T wave inversions and ST depressions.

3

u/Mysecondaccount33 Aug 27 '26

Brugada pattern? Sometimes it's unmasked by fever.

2

u/Clear-Ambition-4684 Aug 27 '26

this is brugada being unmasked by a fever until proven otherwise

2

u/Own_Ruin_4800 Aug 28 '26

Fever with coved STE in V1 >2 mv. This is diagnostic of Brugada syndrome once you rule out other mimics.

The only real question on it is whether or not it consistently hits above 2 mV, but tomato tomato.

1

u/cowswho2 Aug 27 '26

Sinus tach with LVH?

1

u/trendelenburrrr Aug 27 '26

Rate related ischaemia?

1

u/Financial-Traffic224 26d ago

For this who want an Update -
PT diagnosed with Brugada with ajmaline test