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Brugada Flashcards

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1
Q

Neuro dd of Brugada

A

FA- freidrichs ataxia T-thiamine def D-dmd

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2
Q

What will u look for in CXR in Brugada pattern

A

Mediastinal mass compressing RVOT

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3
Q

Echo considerations in Brugada

A 
RA- nil sp 
RV- RVMI,arvd, acute PE
LA-nil sp 
LV-myocarditis 
Ao-dissection
Pericardium-pericarditis, hemopericardium
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4
Q

ECG considerations in Brugada

A

RBBB.,LBBB,LVH,Early repolarisation

Long QT 3

Hyperkalemia,Hypercalcemia

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5
Q

Brugada is due to

A

Sodium channelopathy

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6
Q

Brugada sign is

A

Coved ST >2 mm in 2 or more of V1-3 with neg T wave i.e. Type 1 pattern is called Brugada sign

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7
Q

Brugada sign plus —- diagnoses Brugada syndrome

A

Clinical criteria

  1. VF or Polymorphic VT
  2. Family h/o of SCD less than 45
  3. Brugada sign in family members
  4. Inducible VT in EPS
  5. Syncope (likely due to tachyarrhythmia)
  6. Nocturnal agonal respiration

2005 consensus conference

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8
Q

Mean age of sudden death in Brugada

A

41 yrs

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9
Q

Type 3 Brugada pattern is

A

Less than 2 mm ST elevation

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10
Q

Leads used for Brugada diagnosis

A

V1-3

It’s V1& 2 only as per 2013 HRS Guidelines

Latest as of 2018 April

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11
Q

Non diagnostic Brugada patterns

A

Type 2 and 3

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12
Q

Right precordial leads are

A

V1-2

As per 2013 HRS Guidelines

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13
Q

Common feature of all 3 Brugada patterns

A

J point elevation of 2 mm or more

Not ST segment.

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14
Q

Preferred intercostal space for ECG in Brugada

A

2nd ICS

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15
Q

Type 1 ECG pattern with no clinical criteria is called

A

Idiopathic Brugada ECG pattern

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16
Q

Most controversial topic in Brugada

A

Value of EPS

Dec 2017 review for HRS Guidelines JACC- Doesn’t support EPS in most Asymptomatic Brugada pattern

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17
Q

Only drug which maybe useful in Brugada

A

Quinidine And Amiodarone

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18
Q

Two diseases caused by SCN5A mutations

A

Brugada and Lng QT3 syndrome

Both are autosomal dominant

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19
Q

When does Brugada and Long QT 3 manifest

A

Brugada in adulthood in males

Long QT3 usually in teenage years

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20
Q

Drugs increasing ST elevation in. Brugada

A

Beta blockers, Class I A and C

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21
Q

Drugs which increase ST elevation of Brugada but decreases arrythmogenicity in Long QT 3

A

Beta blockers

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22
Q

Drugs which increases arrythmogenicity in Brugada but reduces in Long QT 3

A

Class I A and C

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23
Q

Brugada pattern in ECG could be an early sub clinical manifestation of

A

ARVD

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24
Q

Brugada syndrome is functional abnormality in

Study These Flashcards
A

Repolarisation

25
HRS ECG criteria which support diagnosis of Brugada syndrome in patient with brugada pattern
1. First degree heart block 2. AF 3. Fragmented QRS 4. ST/T alternans with LBBB ectopics in HOLTER 5. Late potentials on SAE 6. Absence of structural heart disease including ischemia--so..?TMT 7. Some EP features BLAST Fragmented QRS
26
How to differentiate Brugada from RBBB and athletes
At 40 ms of high take off the decrease in amplitude in Brugada is 4 mm or less In RBBB and athletes it is much higher
27
Asymptomatic Brugada pattern what to do
Do nothing . Uptodate 06/2017
28
3 drugs which reduce arrhythmogenicity in Long QT3
Beta blockers ClassI A& C
29
Drugs which reduce arrhythmogenecity in Long QT3
Beta blockers, Class IA& C These drugs increase ST elevation in Brugada
30
Drug given to induce Brugada
Class 1 anti arrhythmic drugs intravenous
31
Precautions for Asymptomatic Brugada who go for sports
Avoid dehydration / electrolyte depletion Avoid fever/ heat exhaustion - treat With antipyretics early Personal AED Avoid large meals and excess Alcohol
32
ECG finding in Brugada
1. Pseudo RBBB & 2. ST elevation In V1 and V2
33
Brugada was introduced as a clinical entity in
1992
34
Brugada causes death in
Young healthy adults Less frequent in infants and children
35
Which guidelines suggested only 2 types of Brugada
2012 consensus report
36
Normal ECG recording amplitude
10mm per mV
37
Brugada syndrome is caused by ————-of———————in the —————-
Inactivation of Sodium channels in Right Ventricle
38
Difference between epsilon wave of ARVD and r’ of Brugada type 2
Epsilon wave is usually separated from the QRS Also no clear ST elevation & Symmetric negative T waves in V1-3
39
Epsilon wave in ARVD represents
Early after depolarizations
40
Epsilon wave is described as a
“Grassy knoll” after the QRS
41
Duration of the base of triangle of r’ 5mm from peak of r more than —— suggests Brugada type 2
>160 ms
42
ECG DD of Type 2 Brugada
iRBBB, P.excavatum, ARVD, Athletes
43
Diagnostic criteria followed for Brugada is the
2013 HRS/EHRA/APHRS expert consensus statement
44
No of leads to diagnose Brugada as per 2013 Guidelines
ONE V1 or V2 Using standard or superior lead placement.
45
ST elevation in Type 1 Brugada
2mm or more At take off
46
Fragmented QRS means
Notching of QRS in presence of narrowQRS- may represent scar
47
The largest international registry of Brugada
SABRUS registry
48
Peak arrhythmic events in Brugada occurs between
38-48 years
49
Common drugs which may unmask Brugada
Beta blockers, Alcohol
50
Patients with Type 2 Brugada should undergo drug challenge if
Family history of SCD below 45 or | Family history of Brugada pattern Type 1
51
The high take off of ST segment in Brugada is due to
Abnormal repolarisation in the RVOT
52
Gene mutation in Brugada
SCN5A
53
The descend of ST at 40 ms in Brugada Type 1versus RBBB or Athletes
4 mm or less in Brugada while more in others i.e slow descend in Brugada
54
Minimum ST elevation at lowest point in Brugada Type 2
0.5 mm r’ takeoff is at least 2mm
55
T wave in Type 2 Brugada
Upright in V2 | Variable in V1
56
2013 Guidelines on when to suspect Brugada syndrome in Type 1 pattern with ECG, Holter, SAECG, EP
``` BLAQ- Block- first degree AV block Left -axis deviation A-Atrial fibrillation Q- QRS Fragmented ``` Holter- ST-T alternans with LBBB ectopics SAECG- done only if high index of suspicion- Late potentials seen EP- not recommended: may be done if additional risk stratfn required. HV interval long, VRP less( Uptodate)
57
Clinical features other than ECG required for Brugada syndrome diagnosis
VAS F2E V- VF/VT-Polymorphic A- Agonal respiration (nocturnal) S- Syncope F-Family history- Death < 45; or Type1 pattern in first degree relative EP- inducible VT 2005 consensus
58
Arrhythmic storm may be defined as
3 or more VT/VF in 24 hours 2013 consensus on arrhythmias
59
Drug to be used to suppress arrhythmic storm in BrS patients
Isoprenaline infusion Also Quinidine For Asymptomatic pts also Quinidine May be considered

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