Brugada Pattern Unmasked by Tricyclic Antidepressant

Brugada Pattern Electrocardiogram Unmasked with Cocaine Ingestion

Cocaine is considered a leading cause of drug-related deaths. This is usually sudden, unwitnessed, and without prodromal features. It has been reported that in-hospital mortality is close to 2%. Cocaine has powerful central nervous system effects(1) and acute cocaine overdose has been associated with hyperthermia, agitation, paranoid ideation, status epilepticus, ventricular fibrillation, ventr...

Brugada ECG Pattern Unmasked by IV Flecainide in an Individual with Idiopathic Fascicular Ventricular Tachycardia

A 45-year old man presents with stable monomorphic ventricular tachycardia. He had previously been diagnosed with idiopathic fascicular ventricular tachycardia. Intravenous flecainide results in termination of his tachycardia but unmasks a latent type 1 Brugada ECG pattern not seen on his resting ECG. We discuss his subsequent management and the need to consider an alternative diagnosis in indi...

Brugada-like electrocardiographic pattern unmasked by fever in a critical care patient.

Sir, Brugada syndrome is a channelopathy associated with right bundle branch block and ST segment elevation in the right precordial leads, V1–V3, in the absence of structural heart abnormalities (1). Mutations in a cardiac sodium channel gene (SCN5A) have been reported as the substrate for the syndrome in some patients (2). Past studies suggested that fever could aggravate the dysfunction of th...

Death by tricyclic: the real antidepressant scandal?

Tricyclic antidepressant toxicity.

Tricyclic antidepressants are dibenzazepine derivatives with adrenergic, anticholinergic, and direct cardio-depressant activity. Double-blind clinical studies show TCAD to be efficacious for two-thirds of depressed patients. Cardiac toxicity is significant, especially on diseased myocardium. Serious arrhythmias and intracardiac blocks have been reported on therapeutic doses. Tricyclic antidepre...