EKG of the Week
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+ EKG Interpretation
Dr. Ohlbaum's Explanation
Starting at the beginning. There is a regular rhythm with clear P waves and a P before every QRS and a QRS after every P. There is nothing extra, and nothing missing, and the rate is 85, so normal sinus rhythm. His P wave is large in the inferior leads suggesting right atrial enlargement. The QRS is normal in size, duration, and axis. There are no pathologic Q waves.
BUT, there is an unusually shaped ST elevation in the right precordial leads consistent with Brugada syndrome.
This patient had a known Brugada syndrome, but this EKG was done when he was here for another problem. Of note, he had an EP study in the past that documented inducible ventricular fibrillation and he has an AICD.
The other interesting thing is that this is a type I Brugada syndrome with a "coved" ST elevation of >2 mm and inverted Tin the right precordial leads. But this patient has had EKGs with BOTH forms of
Brugada syndrome, look at the other side of this paper for same patient's EKG at a different time with the Type II "saddle back" pattern with 2 mm J point elevation and 1 mm overall with upright T wave.
