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Brugada Flashcards

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

A

Repolarisation

25
Q

HRS ECG criteria which support diagnosis of Brugada syndrome in patient with brugada pattern

A
  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
Q

How to differentiate Brugada from RBBB and athletes

A

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
Q

Asymptomatic Brugada pattern what to do

A

Do nothing . Uptodate 06/2017

28
Q

3 drugs which reduce arrhythmogenicity in Long QT3

A

Beta blockers ClassI A& C

29
Q

Drugs which reduce arrhythmogenecity in Long QT3

A

Beta blockers, Class IA& C

These drugs increase ST elevation in Brugada

30
Q

Drug given to induce Brugada

A

Class 1 anti arrhythmic drugs intravenous

31
Q

Precautions for Asymptomatic Brugada who go for sports

A

Avoid dehydration / electrolyte depletion
Avoid fever/ heat exhaustion - treat With antipyretics early
Personal AED
Avoid large meals and excess Alcohol

32
Q

ECG finding in Brugada

A
  1. Pseudo RBBB &
  2. ST elevation

In V1 and V2

33
Q

Brugada was introduced as a clinical entity in

34
Q

Brugada causes death in

A

Young healthy adults

Less frequent in infants and children

35
Q

Which guidelines suggested only 2 types of Brugada

A

2012 consensus report

36
Q

Normal ECG recording amplitude

A

10mm per mV

37
Q

Brugada syndrome is caused by ————-of———————in the —————-

A

Inactivation of Sodium channels in Right Ventricle

38
Q

Difference between epsilon wave of ARVD and r’ of Brugada type 2

A

Epsilon wave is usually separated from the QRS
Also no clear ST elevation &
Symmetric negative T waves in V1-3

39
Q

Epsilon wave in ARVD represents

A

Early after depolarizations

40
Q

Epsilon wave is described as a

A

“Grassy knoll” after the QRS

41
Q

Duration of the base of triangle of r’ 5mm from peak of r more than —— suggests Brugada type 2

42
Q

ECG DD of Type 2 Brugada

A

iRBBB, P.excavatum, ARVD, Athletes

43
Q

Diagnostic criteria followed for Brugada is the

A

2013 HRS/EHRA/APHRS expert consensus statement

44
Q

No of leads to diagnose Brugada as per 2013 Guidelines

A

ONE
V1 or V2

Using standard or superior lead placement.

45
Q

ST elevation in Type 1 Brugada

A

2mm or more

At take off

46
Q

Fragmented QRS means

A

Notching of QRS in presence of narrowQRS- may represent scar

47
Q

The largest international registry of Brugada

A

SABRUS registry

48
Q

Peak arrhythmic events in Brugada occurs between

A

38-48 years

49
Q

Common drugs which may unmask Brugada

A

Beta blockers, Alcohol

50
Q

Patients with Type 2 Brugada should undergo drug challenge if

A

Family history of SCD below 45 or

Family history of Brugada pattern Type 1

51
Q

The high take off of ST segment in Brugada is due to

A

Abnormal repolarisation in the RVOT

52
Q

Gene mutation in Brugada

53
Q

The descend of ST at 40 ms in Brugada Type 1versus RBBB or Athletes

A

4 mm or less in Brugada while more in others

i.e slow descend in Brugada

54
Q

Minimum ST elevation at lowest point in Brugada Type 2

A

0.5 mm

r’ takeoff is at least 2mm

55
Q

T wave in Type 2 Brugada

A

Upright in V2

Variable in V1

56
Q

2013 Guidelines on when to suspect Brugada syndrome in Type 1 pattern with ECG, Holter, SAECG, EP

A 
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
Q

Clinical features other than ECG required for Brugada syndrome diagnosis

A

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
Q

Arrhythmic storm may be defined as

A

3 or more VT/VF in 24 hours

2013 consensus on arrhythmias

59
Q

Drug to be used to suppress arrhythmic storm in BrS patients

A

Isoprenaline infusion

Also Quinidine

For Asymptomatic pts also Quinidine May be considered

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