case of brugada syndrome presented as chest pain STRCT rugada syndrome was described in 1992 as a new clinical entity characterized by electrocardiographic STsegment elevation in the right precordial leads (V1~V3) and the occurrence of sudden cardiac death (SCD) during its clinical course. rugada syndrome is known to be linked with the mutations of SCN5, the gene encoding subunit of the cardiac sodium channel. Furthermore, these abnormal cardiac sodium channels were found to show variable degrees of dysfunctioning in relation to changes in body temperature and electrocardiogram(ecg) findings of rugada syndrome sometimes happen to reveal with the presence of high fever. We experienced a 44-year-old man with rugada syndrome in whom the diagnosis of acute coronary syndrome had been mistakenly made because of an initial clinical presentation with complains of severe chest pain and accompanying ST segment elevations. The ST segment elevations in leads I and avl, which extended the right precordial leads, led the physician to suspect transient pericarditis caused by coexisting pneumonia. In this case, a diagnosis of idiopathic rugada syndrome was reconfirmed by a flecainide challenge test. Key words: brugada syndrome ECG fever chest pain 38 Journal of Cardiac rrhythmia
< < VOL.11 NO.2 39
내원하여, 시행한 심전도상 ST분절의 상승이 V1~V4 유도 열과 동반되어 브루가다 type 1에 해당되는 심전도 소견이 에서 관찰되었으며, 유도 I, avl에서도 ST 상승이 의심되 저명하게 관찰되었고, 폐렴 치료 후 체온의 정상화와 동반 어 진단에 혼선을 빚었던 경우이다. 전산화 단층촬영 소견 되어 심전도 소견 또한 정상화되었던 경우이다. 과 경과 중 발생한 38.5 고열의 발생을 통하여 늑막염이 퇴원 전 flecainide 유발 검사를 시행하여 브루가다 type 동반된 폐렴으로 흉통의 원인진단이 이루어졌으며, 특히 고 1형태의 심전도 변화를 재확인하고 심전기생리 검사를 시 C Figure 1. The twelve-lead ECG on admission: marked ST segment elevations were noted on the right precordial leads (V1-V4) and subtle ST segment elevations also noted in lead 1 and avl (), with a fever of 38.5 on HD 2: rugada Type 1 ECG pattern (), and with normal temperature on HD 7: normal ECG with resolved ST-segment elevation (C). 40 Journal of Cardiac rrhythmia
Figure 2. Chest CT scan on admission showed pulmonary infiltration of the right middle lobe lateral segment, and pulmonary infiltration of the right lower lobe anterobasal segment with pleural involvement. Figure 3. On flecainide provocation test, the baseline electrocardiaram(ecg) showed normal (), and after 5 minutes, the ECG showed the rugada Type 1 ECG pattern (). V5, V6 leads were placed 1 intercoastal space above leads V1 and V2 respectively. VOL.11 NO.2 41
References 1. rugada P, rugada J. Right bundle branch block, persistent ST segment and sudden cardiac death: a distinct clinical and electrocardiographic syndrome. multicenter report. J m Coll Cardiol. 1992;20:1391-1396. 2. Chen Q, Kirsch GE, Zhang D, rugada R, rugada J, rugada P, Potenza D, Moya, orggrefe M, reithardt G, Oritz-Lopez R, Wang Z. Genetic basis and molecular mechanisms for idiopathic ventricular fibrillation. Nature. 1998;392:293-296. 3. Dumaine R, Towbin J, rugada P, Vatta M, Nesterenko DV, Nesterenko VV, rugada J, rugada P, ntzelevitch C. Ionic mechanisms responsible for the electrocardiographic phenotype of the rugada syndrome are temperature dependent. Circ Res. 1999;85:803-809. 4. ntzelevitch C. The rugada syndrome: ionic basis and arrhythmia mechanisms. J Cardiovasc Electrophysiol. 2001;12:268-272. 42 Journal of Cardiac rrhythmia