Brugada Syndrome

Brugada syndrome is an uncommon but occasionally hereditary cardiac rhythm disorder (arrhythmia) that can be fatal. Brugada syndrome patients are more likely to experience irregular heartbeats that start in the lower heart chambers (ventricles).

Preventive methods for Brugada syndrome treatment include lowering the temperature and avoiding drugs that can cause arrhythmia. An implanted cardioverter-defibrillator is a medical device that certain Brugada syndrome sufferers require.

Brugada Syndrome: Causes

An issue with cardiac rhythm is called Brugada syndrome. Special cells in the right upper chamber of the heart provide an electrical signal that starts each heartbeat. Each of these cells has tiny holes known as channels that control the electrical activity that causes the heart to beat.

A shift in these channels results in the heart beating excessively quickly in Brugada syndrome, a potentially hazardous cardiac rhythm (ventricular fibrillation).

The heart, therefore, fails to pump enough blood to the body's other organs. Fainting might be brought on by a brief, erratic rhythm. If the abnormal pulse doesn't cease, sudden cardiac death can happen.

Brugada syndrome might result from −

• A potentially difficult-to-discover structural issue with the heart.

• Chemical imbalance that interferes with the body's ability to communicate electrical impulses (electrolytes)

• Using cocaine or certain prescription drugs

Brugada Syndrome: Symptoms

Brugada syndrome frequently has no discernible symptoms. Many Brugada syndrome sufferers are unaware of their condition.

Brugada syndrome may show the following signs and symptoms −

• Dizziness

• Fainting

• Breathing that is difficult, especially at night

• Irregular or palpitating heartbeats

• Incredibly rapid and erratic pulse

• Seizures

An abnormal electrocardiogram (ECG) result, a test that gauges the electrical activity of the heart, is a key indicator of Brugada syndrome.

Emergency medical attention is needed for Brugada syndrome complications. Complications of the Brugada syndrome include −

• Unexpected cardiac arrest. This rapid loss of breathing, awareness, and heart function, which frequently happens while you're asleep, is fatal if it is not treated very away. Survival is feasible with prompt, effective medical care.

• Fainting. When someone has Brugada syndrome, fainting needs immediate medical intervention.

Brugada Syndrome: Risk Factors

The major risk factors include −

• History of Brugada syndrome in the family. This disease is frequently inherited within families (inherited). One's likelihood of developing Brugada syndrome is further increased by having family members who do.

• Being a man. Brugada syndrome is more often diagnosed in men than in women.

• Race. Asians experience Brugada syndrome more commonly than members of other races.

• Fever. Brugada syndrome is not brought on by temperature, although it can irritate the heart and lead to fainting or sudden cardiac arrest in Brugada syndrome sufferers, particularly in young children.

Brugada Syndrome: Diagnosis

Brugada syndrome is often diagnosed in adults, while it can sometimes occur in teenagers. Young children are seldom diagnosed with it since the symptoms are frequently ignored.

A medical professional will do a physical examination and use a stethoscope to listen to the heart to diagnose Brugada syndrome. To examine the heartbeat and identify or confirm Brugada syndrome, tests are performed.

ECG

ECGs can be performed with or without medication. The electrical impulses in the heart are captured by an ECG, a simple and painless examination. Sensors (electrodes) are affixed to the chest and occasionally the limbs during an ECG.

The procedure can identify issues with the heart's rhythm and architecture. If the test results show that the heartbeat is regular, the next step can involve wearing a portable ECG all day and all night. A 24-hour Holter monitor test is the name for this kind of examination.

Although some persons have Brugada syndrome symptoms, their first ECG and 24-hour Holter test findings are within the normal range. These persons might also have further ECGs that include tests for drugs administered intravenously that might cause irregular heartbeats.

Echocardiogram

Sound waves are used in an echocardiogram to produce pictures of the heart. Although this test is unable to independently diagnose Brugada syndrome, it can aid in the detection of cardiac structural issues.

Testing and Mapping Electrophysiological (EP) Processes

Some persons with suspected Brugada syndrome may have this test, commonly known as an EP study. In this test, medical professional inserts thin, flexible tubes (catheters) with electrode tips into various parts of the heart's blood veins. After the electrodes are in situ, they can display how electrical signals move throughout the heart.

Brugada Syndrome: Treatment

Medication, catheter procedures, or surgery to implant a heartbeat control device are all possible treatments for Brugada syndrome. Treatment for Brugada syndrome is based on the likelihood of developing a significant irregular heartbeat (arrhythmia).

A high-risk situation includes −

• A history of life-threatening arrhythmias

• Fading spells

• Lived through a sudden cardiac arrest

Brugada syndrome may not require special treatment if there are no symptoms, as there is probably little chance of a major abnormal heartbeat. Nonetheless, a medical professional could advise taking precautions to lower the risk of irregular heartbeats.

• Aggressively treat a fever. Those with Brugada syndrome are known to experience abnormal heartbeats while they are feverish. When a fever initially appears, use drugs that lower the temperature.

• Avoid using medications that might cause an irregular heartbeat. Many medicines, including antidepressants and several cardiac medications, might raise the chance of having an irregular heartbeat. Alcohol abuse might also raise the risk. All of your medications, including over-the-counter remedies and prescription prescriptions, should be disclosed to your healthcare professional.

• Avoid engaging in sporting competitions. Those who are highly susceptible to a significantly irregular heartbeat may be affected by this. If you're unsure about whether you should stay away from certain sports, ask your doctor.

Medications

Some Brugada syndrome sufferers are given drugs, including quinidine, to stop potentially hazardous cardiac rhythms. These medications may be provided separately or together with a heartbeat-controlling medical device known as an implanted cardioverter-defibrillator (ICD).

Treatments such as Surgery

Surgery or catheter treatment may be required for Brugada syndrome patients who have experienced a cardiac arrest or a concerning episode of fainting.

• Cardioverter-defibrillator implant (ICD). This tiny battery-powered gadget is inserted into the chest to continually track the heartbeat.

• Ablating a catheter. A treatment known as radiofrequency catheter ablation may be a possibility if an ICD is unable to effectively and safely control Brugada syndrome symptoms.

Brugada Syndrome: Prevention

Genetic testing can be done to find out if you have Brugada syndrome or are at risk of developing it if someone in your family has the disorder.

Conclusion

A Brugada syndrome diagnosis must be made in a patient without a personal or family history of the condition since a single person's initial diagnosis affects their whole family. Patients must also be warned against using anesthetics, antihistamines, cocaine, antiarrhythmics, and psychiatric medications because these substances have been shown to exacerbate Brugada syndrome.

The sudden symptomatology, high mortality rate, and propensity for the unusual presentation of Brugada syndrome make it a difficult illness to treat. Because of all of these factors, Brugada syndrome will continue to pose a serious hazard to human life that emergency doctors must be able to identify and treat.