Elsevier

Journal of Electrocardiology

Volume 41, Issue 6, November–December 2008, Pages 690-692
Journal of Electrocardiology

Hypothermia-induced Brugada-like electrocardiogram pattern

https://doi.org/10.1016/j.jelectrocard.2008.05.001Get rights and content

Abstract

A patient in whom moderate hypothermia developed after prolonged cardiopulmonary resuscitation is described. Hypothermia was manifested by transient electrocardiogram changes, including long QT, precordial J waves, and downsloping ST-segment elevation ending in a negative T wave in leads V1 and V2 resembling the Brugada syndrome. The physiopathologic mechanisms of these electrocardiographic findings are discussed.

Introduction

Although hypothermia has been listed as a cause of Brugada-like electrocardiogram (ECG) pattern,1, 2 clinical cases of right precordial ST-segment elevation mimicking Brugada syndrome (BrS) have rarely been reported in the hypothermia setting.3, 4 We report a patient with moderate hypothermia who developed a transient Brugada sign characterized by precordial J waves and coved ST-segment elevation ending in a negative T wave in leads V1 and V2.

Section snippets

Case report

A 78-year-old man with chronic obstructive pulmonary disease was hospitalized after prolonged bystander resuscitative effort for gasping. His relatives denied any previous history of malignant arrhythmias, syncope, or family episodes of sudden death. His family members did not show any ECG pattern of BrS. On admission, the patient was unconscious, bradycardic, bradypneic, and hypothermic. There was also subcutaneous emphysema and absence of left breath sound due to left tension pneumothorax. He

Discussion

The BrS is characterized by a right precordial ST-segment elevation and a high incidence of sudden death in patients with structural normal heart (ion channel cardiomyopathy).1, 5, 6, 7 Although 3 ECG repolarization patterns in the right precordial leads are recognized, only the type 1 (coved ST-segment elevation ≥2 mm and inverted T wave) is diagnostic of BrS. This pattern can be observed spontaneously or after the administration of sodium channel blocks. Although hypothermia can produce J

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    Under extreme hypothermia or hyperthermia core body temperature may go below 35 °C or rise to 45 °C, respectively (Suchard, 2007; Tokutomi et al., 2009). Case studies show that the effects of hyperthermia or hypothermia on BrS are varied, potentially due to different environmental or genetic factors (Kum et al., 2002; Ortega-Carnicer et al., 2008; Porres et al., 2002). Many case studies show hyperthermia has detrimental effects on asymptomatic BrS patients causing the BrS patterns to be unmasked under febrile conditions and remain unmasked upon restoration of core body temperature (De Marco et al., 2012; Dumaine et al., 1999; Ozeke et al., 2005).

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