Transient Brugada-type electrocardiographic abnormalities in renal failure reversed by dialysis.
The Brugada syndrome (BRS) is a hereditary cardiac condition (characteristically with a gene mutation affecting sodium channel function) identified by an elevated terminal portion of the QRS complex (prominent J wave) followed by a descending ST-segment elevation ending in a negative T wave in the right precordial leads, and malignant tachyarrhythmias in patients without demonstrable structural heart disease. We report a patient with a previous history of epilepsy treated with psychotropic drugs (with a sodium channel blocking effect) and chronic renal failure on haemodialysis who developed hyperkalaemia (6.6 mmol/l) and ECG findings resembling BRS. This condition was manifested by the prominent J wave, the coved-type ST-segment elevation and the negative T wave in the right precordial leads. These ECG changes disappeared after haemodialysis when the potassium became normal. Subsequently, a flecainide test did not reproduce ST-segment elevation. We conclude that hyperkalaemia associated with cardiac membrane active drugs may cause ECG changes mimicking the Brugada syndrome.
Ortega-Carnicer
Julián
J
Intensive Care Unit and Nephrology Service, Hospital Alarcos, Av Pio XII s/n, 13002 Ciudad Real, Spain. jortegacar@nexo.es
Benezet
Juan
J
Ruiz-Lorenzo
Francisco
F
Alcázar
Roberto
R
D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects*; D002037:Bundle-Branch Block / Q000175:diagnosis* / Q000209:etiology; D004452:Echocardiography; D004562:Electrocardiography; D004827:Epilepsy / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D005500:Follow-Up Studies; D006801:Humans; D006947:Hyperkalemia / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D006435:Renal Dialysis / Q000379:methods; D018570:Risk Assessment; D013577:Syndrome
D000927:Anticonvulsants