Transient Brugada Like after Scorpion Sting: An Unexpected Connection
Rim ZERHOUDI *
Cardiology Department, ERRAZI Hospital, Mohammed VI University Hospital, Marrakech, Morocco.
Khaoula BOURZEG
Cardiology Department, ERRAZI Hospital, Mohammed VI University Hospital, Marrakech, Morocco.
Ayoub MOUHSSINE
Cardiology Department, ERRAZI Hospital, Mohammed VI University Hospital, Marrakech, Morocco.
Joumana ELMASRIOUI
Cardiology Department, ERRAZI Hospital, Mohammed VI University Hospital, Marrakech, Morocco and Physiology Department, ERRAZI Hospital, Mohammed VI University Hospital, Marrakech, Morocco.
Mohammed EL JAMILI
Cardiology Department, ERRAZI Hospital, Mohammed VI University Hospital, Marrakech, Morocco.
Sofia OUBAHA
Physiology Department, ERRAZI Hospital, Mohammed VI University Hospital, Marrakech, Morocco.
Mustapha ELHATTAOUI
Cardiology Department, ERRAZI Hospital, Mohammed VI University Hospital, Marrakech, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Introduction: Brugada syndrome was described in 1992 as a new clinical and electrocardiographic syndrome involving susceptibility to ventricular arrhythmias and sudden cardiac death in patients without obvious structural heart disease. Brugada phenocopy (BrP) is an evolving term for Brugada-like ECG patterns due to reversible causes. In this article, we will illustrate the case of a patient presenting with a transient Brugada pattern following a scorpion sting.
Case Report: A 65-year-old woman with age and menopause as cardiovascular risk factors, but no notable medical history, presented to the emergency department with atypical chest pain five hours after a scorpion sting. She had no associated symptoms such as dyspnoea, syncope, or palpitations, nor a personal or family history of sudden death. On admission, she was conscious, hemodynamically stable, normotensive, and tachycardic, with no signs of heart failure. Her ECG showed a 2 mm elevation at the J point and an inverted T wave in V1 and V2, indicating a Brugada pattern. She was admitted to the ICU for close monitoring. An echocardiogram revealed normal left and right ventricular function. Lab tests showed negative troponins, a normal blood ionogram, and normal renal and hepatic function. The Brugada pattern resolved within a few hours, and the patient remained stable.
Discussion and Conclusion: Our case highlights the importance of conducting a thorough medical history to rule out the presence of arrhythmia, syncope, or a family history of sudden cardiac death in similar situations. If the history raises concerns, cardiological follow-up is essential to investigate the possibility of Brugada syndrome. Performing a follow-up ECG at discharge is beneficial to confirm the reversibility of the findings. This distinction is crucial as it helps differentiate between Brugada syndrome and the Brugada pattern, the latter being a condition that may occur in patients with scorpion stings or other triggers.
Keywords: Scorpion sting, venom, chest pain, Brugada pattern, reversibility