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A few decades ago all suddencardiacarrests with documented ventricular fibrillation (VF) and structurally normal hearts were diagnosed as idiopathic ventricular fibrillation (IVF).
During the intravenous lacosamide infusion, the patient developed suddencardiacarrest caused by ventricular arrhythmias necessitating resuscitation. Of note, the patient had a family history of suddencardiacdeath.
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. Induced Brugada-type electrocardiogram, a sign for imminent malignant arrhythmias. Circulation, 117, 1890–1893.
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.
Essential Reading : Full text link: AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram, Part IV: The ST Segment, T and U Waves, and the QT Interval (full text link). Answer : you must treat the patient's underlying condition causing sinus tachycardia, and repeat the ECG at the lower heart rate.
Further history later: This patient personally has no further high risk features (syncope / presyncope), but her mother had suddencardiacarrest in sleep. Twenty-one percent (18 of 88) had a family history of suddencardiacdeath and 26.4% (14 of 53) carried a pathogenic SCN5A mutation. months).
The clinical significance of ARCA-LCS lies in its potential to cause myocardial ischemia or suddencardiacdeath, particularly under physical exertion. Transthoracic echocardiogram, bilateral carotid Doppler ultrasound, and electrocardiogram were normal. No previous history of hypertension or diabetes.
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