Example 24

The ECG

• Following the 7+2 steps:
  • Rhythm
    • The ECG shows a regular rhythm. Every P wave is followed by a QRS complex. P waves are positive in I and AVF. Normal sinus rhythm
  • Heart rate
    • about 80bpm
  • Conduction (PQ,QRS,QT)
    • In lead II: PQ: 210ms QRS: 90ms QT: 380ms QTc: 450ms
  • Heartaxis
    • QRS positive in I and AVF: normal heart axis
  • P wave morphology
    • Broad based P waves
  • QRS morphology
    • Normal QRS complexes
  • ST morphology
    • Typical ST elevation in V1, V2 and V3, with a coved type morphology in V1.
  • Compare with the old ECG (not available, so skip this step)
  • Conclusion?

Typical Brugada syndrome ST segments in right precordial ECG leads (on spot diagnosis) aka 'type-1 Brugada ECG' with 1st degree AV block and broad P-waves.

Atrial/AV/ventricular conduction delay is commonly seen in Brugada syndrome, in this patient there is atrial and AV conduction delay. Brugada syndrome is associated with malignant arrhythmias (VT/VF) and sudden death although many patients may not experience any symptoms throughout their life.