294 BEYOND BRUGADA SYNDROME: A COMMON ECG PATTERN IN AN UNCOMMON CLINICAL SCENARIO

Abstract Propofol infusion syndrome (PRIS) is a rare but potentially lethal side effect of propofol. In most cases it shows various combinations signs such as unexplained metabolic acidosis, rhabdomyolysis, hepatomegaly, renal failure, hypertriglyceridemia, malignant arrhythmia and rapidly progressive cardiac failure. The development coved ST elevation in the right precordial leads electrocardiogram (ECG), similar to that seen type I Brugada may be first sign instability. There no specific treatment for PRIS. Successful management consists an early recognition its followed by prompt propofol termination. We present case 35-year-old male affected mild hypertension. He was found his wife during transitory loss consciousness episode. had resulted positive Sars Cov 2 infection day before symptomatic fever myalgia. An ambulance immediately called patient transferred emergency department suspected out-of-hospital-cardiac arrest. initial one-lead ECG performed physician unremarkable. On arrival he coma state with stable hemodynamics. showed only asymmetric T wave inversion V4-V6 leads. echocardiogram did not show any major alterations. meantime, due worsening respiratory function, orotracheal intubation sedated propofol, midazolam fentanyl. Subsequently, episode atrial fibrillation documented. Amiodarone started reverted sinus rhythm after few hours. following two episodes Torsade de Pointes prolonged QTc (660 ms) occurred. These arrhythmias were treated successfully magnesium sulfate infusion. Blood analysis severe hypokalemia corrected. After hemodynamic stabilization pattern highly resembling 1 Moreover CPK, myoglobin, high sensitivity troponin levels rise, along creatinine, triglycerides markers hepatic injury. been administered continuously eight days, so PRIS primum movens this clinical scenario. interrupted. Thereafter, gradually improved extubated. As soon patient's conditions allowed it, coronary CT MRI performed, To further evaluate case, flecainide challenge test significant change induced. Nonetheless, given both history ventricular arrhythmia, young age subcutaneous defibrillator implanted form secondary prevention.