A 45-year-old patient has been admitted to the hospital for investigation of syncope. A MET call is made for another syncopal episode. The 12 lead ECG is shown.
a. Explain the ECG changes. (10%marks)
b. List the most likely diagnosis. (10% marks)
c. Explain the underlying pathophysiology. (10% marks)
d. List four clinical situations that can worsen this condition. (20% marks)
Aim: To allow the candidate to demonstrate expertise in the analysis of ECGs.
Key sources include: This is a repeat question from paper 2014.1 Q18. CanMEDS Medical Expert.
15.2 - Brugada syndrome was not identified and was misdiagnosed on the ECG in many cases.
This SAQ was a repeat of Question 18.2 from the first paper of 2014, and so the image and interpretation were also a repeat. From that past SAQ, the following "college model answer" could be obtained:
The criteria for the diagnosis of Brugada syndrome as well as are explored to a fascinating depth by Edward Burns in his article for LITFL. The time-poor exam candidate will be interested in only the answers to this question:
Clinical situations which can worsen this condition:
Berne, Paola, and Josep Brugada. "Brugada syndrome 2012." Circulation Journal 76.7 (2012): 1563-1571.