Abstract 20133: Not All ST Elevations Mandate Emergent Catheterization: A Case Report of Brugada Syndrome Induced by Severe Hyponatremia

Introduction: Brugada syndrome is a rare channelopathy, which is familial or sporadic in occurrence. Typical ECG findings of Brugada pattern consist of a pseudo-right bundle branch block and persistent ST segment elevation in leads V1 to V2. While fever, stressors and sodium channel blockers have been implicated in unmasking the underlying rhythm, only 2 cases of hyponatremia precipitating Brugada Syndrome have been reported to date. Here in, we report a case of a 61 y/o woman who underwent emergent cardiac catheterization after her EKG demonstrated ST elevation in the anterior leads. Eventual work up revealed Brugada Syndrome induced by hyponatremia. Case: A 61 y/o woman with a known medical history of hyponatremia from chronic alcohol abuse was found to be unresponsive at home. EKG performed by paramedics revealed ST elevation in anterior leads. Based on the EKG and the patient’s presentation, a probable diagnosis of cardiac arrest from ischemic heart disease was made and a decision for emergent cardiac catheterization was made. Catheterization revealed, mild non-obstructive coronary artery disease. The patient was transferred to ICU for further care where she continued to remain unresponsive. Initial work up revealed severe hyponatremia, with a serum sodium of 103. The rest of her electrolytes were within normal limits. Detailed review of her presenting EKG revealed that she had “coved” pattern of ST elevation in the anterior leads. Her severe hyponatremia was corrected with hypertonic saline. Subsequent EKG’s after partial correction of hyponatremia demonstrated resolution of abnormal EKG changes. Conclusion: The patient described in this case had a cardiac arrest most likely from sustained ventricular tachycardia secondary to a brugada pattern. Hence, hyponatremia should be recognized as an important etiology in the list of causes that unmask a Brugada pattern in patients with this channelopathy.