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AN UNCOMMON STEMI MASQUERADER: A CASE OF IMIPRAMINE INDUCED BRUGADA PHENOCOPY (BRP)

Authors: Kovvuri Hari Lalith Reddy , Gollapalli Sajit Kishan and A. Satyendra Kumar;

AN UNCOMMON STEMI MASQUERADER: A CASE OF IMIPRAMINE INDUCED BRUGADA PHENOCOPY (BRP)

Abstract

Brugada syndrome(BrS) is an arrhythmogenic disorder characterized by a bulging ST-segment elevation and a J-point elevation of at least 2 mm in at least two of the right precordial electrocardiogram (ECG) leads (V1-3). It has an incidence of 4 to 12% in sudden cardiac death (SCD) patients due to ventricular tachycardia (VT) or ventricular fibrillation (VF). The Brugada type 1 ECG pattern may occur in various conditions independent of the actual syndrome, and this clinical phenomenon is often referred to as Brugada phenocopy (BrP). A wide variety of other drugs have been reported to unmask or induce Brugada phenotype which may otherwise be concealed, including antianginals, antidepressants, antipsychotics, and antihistamines. In this article, we present a case of Drug-induced BrP due to Imipramine. A 60-year-old hypertensive female patientwith 3 days of chest pain, who was referred to us as possible Acute Coronary Syndrome (ACS) by a general practitioner. She had a history of psychiatric illness and her ECG showed type 1 Brugada pattern with elevation of the J point with an elevation of the curved ST segment in leads V1 to V3. We found that the patient had been taking imipramine for 8 years due to her psychiatric disorder. Psychiatric opinion was sought and drug induced Brugada was suspected following which Imipramine was discontinued. After 2 weeks of follow-up there was resolution of the ST-T changes on the ECG, supporting the diagnosis of drug-induced BrP.

Keywords

Brugada Syndrome (BrS) Brugada Phenocopy (BrP) Drug induced Brugada Syndrome ST Elevation MI Masqueraders TCAs Ventricular Tachycardia Sudden Cardiac Death (SCD)

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selected citations
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This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
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