Question 23.3

A 35-year-old male is brought to the Emergency Department after an out-of-hospital cardiac arrest. His ECG (ECG 23.3) is shown on page 11.

a)    What was the likely underlying rhythm at the time of the arrest? Please provide your reasoning.
(10% marks)

b)    List three likely aetiologies for these abnormalities.    (15% marks)

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College answer

Not available.

Discussion

The college answer and ECG image were both not available at the time of writing, so it is impossible to accurately reconstruct the original ECG. This could have also been long QT syndrome (this time a congenital one, because the patient is young) but because we've already used that for another question in this paper, this one had to be something else. Let's go with Brugada syndrome. This ECG is recycled from Question 18.2 from the first paper of 2014.

a) The most likely rhythm would have been polymorphic VT or VF, as that is one of the diagnostic criteria for Brugada syndrome, and the ECG demonstrates characteristic ECG changes:

  • "Coved" ST elevation:  the QRS complex finishes high, and the ST-segment slopes diagonally to form an inverted T-wave in V1 and V2
  • Inverted T waves

b) Three possible aetiologies here are:

References

Berne, Paola, and Josep Brugada. "Brugada syndrome 2012." Circulation Journal 76.7 (2012): 1563-1571.

Hauer, R. N. W. "Brugada Syndrome or Brugada Mimicry?." Cardiac Arrhythmias 2003. Springer, Milano, 2004. 335-338.

Aksu, Uğur, et al. "Massive pulmonary embolism mimicking electrocardiographic pattern of Brugada syndrome." The American journal of emergency medicine 34.5 (2016): 933-e1.

Mehta, Sahil, et al. "Hypercalcemia due to rhabdomyolysis mimicking Brugada syndrome." Pacing and clinical electrophysiology 32.11 (2009): e14.