Case 54: A 65-Year-Old Woman in the Medical ICU
History
Diagnosis
ECG 2
ECG 2 Diagnosis
ECG 3
History
A 65-year-old schizophrenic woman, known to have obstructive lung disease, is admitted to the medical ICU with left lower lobe pneumonia and severe hypoxia:
Diagnosis
- Sinus tachycardia, 100/min
- Right axis deviation
- Low QRS voltage
ECG 2
On the 2nd hospital day she has high fever (43 degrees C) and her ECG is as follows:
ECG 2 Diagnosis
- Sinus rhythm, 98/min.
- Incomplete right bundle branch block (iRBBB)
- ST elevation in V1-V3 compatible with Brugada pattern (type 1)
ECG 3
With antibiotic therapy the temperature drops to 37.8 and the ECG returns to the previous pattern.
Comments: Domaine et al. have demonstrated that the premature inactivation of the sodium channel in SCN5A mutation (associated with the Brugada syndrome) is a function of temperature. Fever can often unmask the Brugada syndrome.
ECG ID: E411