title: Brugada syndrome-like ST-segment elevation increase exacerbated by vomiting.
abstract: The patient was a 53 year-old male who had 3 syncopal episodes over a 6-month period. In the electrophysiological study, ventricular fibrillation (VF) was repeatedly induced by the ventricular extrastimulus method. Intravenous pilsicainide was administered, and the J-point and ST-segment in the right precordial leads became slightly elevated just following drug administration. Five min later, the patient experienced severe nausea and then vomited twice, at which point the electrocardiogram (ECG) showed increased elevation of the J-point and ST-segment. These ECG changes recovered to normal 30 min later. The cause of his syncope was strongly suspected to be related to the VF associated with Brugada syndrome. An interesting aspect of this case was the particular type of J-point and ST-segment elevation that was induced when the patient experienced nausea and vomiting. It is proposed that this phenomenon originated from the vagal stimulation associated with the nausea and vomiting.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Mariko
authors.initials: M
authors.lastname: Arai
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Nakazawa
authors.forename: Akihiko
authors.initials: A
authors.lastname: Takagi
authors.forename: Ryoji
authors.initials: R
authors.lastname: Kishi
authors.forename: Keizo
authors.initials: K
authors.lastname: Osada
authors.forename: Syonosuke
authors.initials: S
authors.lastname: Ryu
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Miyake
mesh_terms: D000109:Acetylcholine / Q000494:pharmacology; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003331:Coronary Vessels / Q000187:drug effects / Q000503:physiopathology; D004562:Electrocardiography; D006801:Humans; D007262:Infusions, Intravenous; D008012:Lidocaine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D013577:Syndrome; D014693:Ventricular Fibrillation / Q000503:physiopathology*; D014839:Vomiting / Q000503:physiopathology*
chemical_list: D000889:Anti-Arrhythmia Agents; D008012:Lidocaine; C042288:pilsicainide; D000109:Acetylcholine