Brugada Syndrome: Causes, Symptoms, Diagnosis, Treatment, and Prevention
The Brugada syndrome is a rare, but potentially life-threatening heart rhythm disorder that is sometimes inherited. A person with Brugada syndrome is at greater risk of developing irregular heart rhythms in the lower chambers of the heart (ventricles). It can cause fainting, seizures, or sudden cardiac arrest.
Causes of Brugada Syndrome
Brugada syndrome is caused by a change in the electrical activity of the heart, which affects the way the heart beats. The change can be due to:
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A genetic mutation in the gene SCN5A, which regulates the sodium channels in the heart cells. This mutation can be inherited from one or both parents, or occur spontaneously.
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A structural problem in the heart, such as a congenital defect, a scar, or an infection, that alters the electrical conduction in the heart.
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An imbalance in the electrolytes, such as potassium, calcium, or magnesium, that help transmit electrical signals in the body.
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Certain medications or substances, such as sodium channel blockers, antidepressants, or cocaine, that can trigger or worsen the abnormal heart rhythm.
Symptoms of Brugada Syndrome
Most people with Brugada syndrome have no noticeable symptoms. They are often unaware that they have it. However, there are some symptoms that may be associated with Brugada syndrome:
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Dizziness
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Fainting
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Gasping and labored breathing, especially at night
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Irregular heartbeats or palpitations
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Extremely fast and chaotic heartbeat
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Seizures
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Cardiac arrest
The symptoms usually occur during sleep or at rest, and are more common in men than in women. They may also be triggered by fever, alcohol, or stress.
Diagnosis of Brugada Syndrome
An electrocardiogram (ECG), which records the electrical signals in the heart, is used to diagnose Brugada syndrome. An ECG can reveal a characteristic pattern of heart rhythms that indicates Brugada syndrome, known as the Brugada sign.
As the Brugada sign may not always be visible on the ECG, it can vary depending on the time of day, the body temperature, or the medications taken. Therefore, additional tests may be needed to confirm the diagnosis, such as:
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A 24-hour Holter monitor, which is a portable device that records the heart rhythm continuously for a day.
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A genetic test, which can detect the mutation in the SCN5A gene or other genes related to Brugada syndrome.
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An echocardiogram, which uses sound waves to create images of the heart and check for any structural problems.
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An electrophysiology (EP) study, which involves inserting catheters with electrodes into the heart and stimulating the heart to provoke the abnormal rhythm.
Treatment of Brugada Syndrome
Brugada syndrome cannot be cured, but treatment can help manage the dangerous arrhythmias and reduce the risk of complications. The treatment options depend on the severity of the condition and the risk of sudden cardiac death.
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Medications, such as anti-arrhythmic drugs, that can help stabilize the heart rhythm and prevent the ventricular fibrillation.
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A procedure called catheter ablation, which involves destroying the abnormal tissue in the heart that causes the arrhythmia, using radiofrequency energy or freezing.
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Implantable cardioverter-defibrillators (ICD), which are surgically implanted under the skin and connected to the heart by wires, can monitor the heart rhythm and deliver an electrical shock if needed.
Prevention of Brugada Syndrome
Brugada syndrome cannot be prevented, but some measures can be taken to reduce the risk of triggering or worsening the arrhythmia, such as:
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Avoiding drugs or substances that can affect the heart rhythm, such as sodium channel blockers, antidepressants, or cocaine.
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Treating fever promptly with fever-reducing medications, such as acetaminophen or ibuprofen, as fever can increase the risk of arrhythmia.
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Avoiding vigorous physical activity, especially in hot or humid conditions, as it can raise the body temperature and stress the heart.
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Seeking medical attention immediately if any symptoms of Brugada syndrome occur, such as fainting, palpitations, or seizures.
People with Brugada syndrome can live a normal and active life with proper treatment and care, which involves regular monitoring and follow-up with a cardiologist.
