Syncope due to Brugada syndrome — RCPSC EM MCQ

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HardCardiovascular emergenciesSyncope due to Brugada syndromeRCPSC EM

A 32-year-old has nocturnal syncope during a febrile illness. ECG shows coved ST elevation in V1–V2 followed by T-wave inversion; electrolytes and troponin are normal. Which ECG syndrome best explains this presentation?

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Correct answer: A — Brugada syndrome

The best answer is “Brugada syndrome”. The spontaneous type-1 Brugada ECG pattern is coved ST-segment elevation in the right precordial leads followed by T-wave inversion, and fever can unmask it. Syncope in this context raises concern for malignant ventricular arrhythmia and needs urgent cardiology or electrophysiology assessment. Pericarditis and early repolarization have different ST morphology, while Wellens syndrome is an anterior ischaemic pattern.

Reference: Canadian Cardiovascular Society: Inherited Arrhythmia Syndromes and Cardiomyopathies: https://ccs.ca/guideline/drive-2023/4-inherited-arrhythmia-syndromes-and-cardiomyopathies/