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This is a critically important determination because of the 2017 AHA/ACC/HRS Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of SuddenCardiacDeath. Frick — "Angiography can be misleading — and must always be understood in clinical context".
This discussion comes from this previous post: Hyperthermia and ST Elevation Discussion Brugada Type 1 ECG changes are associated with suddencardiacdeath (SCD) and the occurrence of ventricular dysrhythmias. See more cases of Brugada due to fever here. per year. Heart Rhythm, 15(9): 1394-1401. [7]
Brugada syndrome is thought to account for about one fourth of suddencardiacdeaths in individuals with structurally normal heart. 2017 Mar;110(3):188-195. Even though mutations in other channels have been described in Brugada syndrome, only those in SCN5A gene are considered to be definitely disease causing.
The limb lead abnormalities appear to be part of the Brugada pattern, as described in this article: Inferior and Lateral Electrocardiographic RepolarizationAbnormalities in Brugada Syndrome Discussion Brugada Type 1 ECG changes are associated with suddencardiacdeath (SCD) and the occurrence of ventricular dysrhythmias.
12,16 In 2017, CANTOS (Canakinumab Anti-inflammatory Thrombosis Outcomes Study) provided proof-of-principle that inflammation inhibition in the absence of lipid lowering can significantly reduce cardiovascular event rates and helped to define the interleukin-1 (IL-1) to IL-6 to CRP pathway as a central target in CV disease.16
However, according to these diagnostic criteria (JACC 2011; 57(7):802), it is a Bazett corrected QT of less than 330-370, depending on other diagnostic criteria, including 1) h/o cardiacarrest, 2) sudden syncope, 3) family hx of sudden unexplained arrest at age less than 40, 4) family hx of SQTS.
Further history later: This patient personally has no further high risk features (syncope / presyncope), but her mother had suddencardiacarrest in sleep. This is based on the Sieira et al, 2017, risk calculator , which gives a borderline risk score (2). years and 71.6% (67 of 88) were men. y (3 of 88, 43.6 ± 37.4
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