Brugada syndrome: syncope in the younger patient and the risk of sudden cardiac death

Brugada syndrome is inherited as an autosomal dominant condition with variable penetrance and is caused by three different mutations on the cardiac sodium channel gene SCN5A which results in sodium channel dysfunction. 5 The diagnosis of Brugada syndrome should be considered in any person who has experienced syncope, nocturnal agonal respiration, documented ventricular fibrillation, self-terminating polymorphic ventricular tachycardia, or where there is a family history of sudden cardiac death. 6 Diagnostic difficulties may arise in patients who present with syncope as these events can sometimes mimic seizure disorders with witness reports of tonic-clonic movement of extremities and urinary incontinence. 7 Problems may also arise with the misinterpretation of the ECG changes thus leading to the administration of thrombolytic therapy in those with concomitant chest pain. 8 Despite these diagnostic pitfalls the emergency physician evaluating the post-syncopal patient should consider the diagnosis of Brugada syndrome.