Brugada syndrome detected at the prehospital level

Abstract

Introduction/Objective Brugada syndrome (BS) is becoming less of a mystery and more of a challenge for early recognition and treatment. We are presenting the case of a patient with Brugada syndrome recognized at the prehospital level. Case report The Emergency Medical Team (EMT) treated a 23-year-old Syrian native, who had fallen ill in a public place. He declared that he had experienced chest pain, 7/10 in strength, and weakness on the left side of his body followed by a short-term collapse some 20 minutes earlier. After that, he felt weak, languid, very tired and had neck pain. As declared by witnesses, he did not lose consciousness, but was confused, pale, covered with sweat and was breathing rapidly. All this happened after a prolonged quick-paced walk in high air humidity conditions. He declared that he hadn't had similar episodes before, nor had he had significant injuries, allergies or chronic diseases. There was no sudden cardiac death history in his family. Upon examination, he was conscious, afebrile, eupnoeic (18 breaths per minute) with normal heart frequency (70 per minute), blood pressure of 120/90 mmHg and blood oxygen saturation level of 100%. His heart and breath sounds were normal. All other physical examination findings were normal as well. ECG: sinus rhythm, 70 beats per minute, saddleback ST-segment elevation > 1mm in V2. An IV line was inserted and an ECG monitor placed. He was transported to the hospital with the diagnosis of having collapsed and a suspected Brugada syndrome. After short observation and a repeated ECG recording, the Brugada syndrome type II diagnosis was confirmed. Conclusion The Emergency Medical Team doctor must recognize the ECG pattern of this disease, apply necessary CPR measures including early defibrillation if needed, and closely monitor the ECG and vital signs of the patient during transport.