Syncope and Brugada-like ECG pattern in a patient with syndrome of inappropriate antidiuretic hormone secretion (SIADH)
  • Muhammad Azhar Rosyidi
    Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Brawijaya, Saiful Anwar General Hospital, Malang, Indonesia
  • Valerinna Yogibuana
    Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Brawijaya, Saiful Anwar General Hospital, Malang, Indonesia
  • Ardian Rizal
    Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Brawijaya, Saiful Anwar General Hospital, Malang, Indonesia

Keywords

Syncope, SIADH, Brugada-like ECG pattern, syndrome of inappropriate antidiuretic hormone secretion

Abstract

Syncope is a brief loss of consciousness caused by reduced blood flow to the brain, characterised by sudden onset, short duration and full recovery without intervention. Anamnesis, physical examination and other diagnostic tests such as laboratory analysis and electrocardiogram (ECG) can be conducted to identify the underlying cause of syncope. A Brugada pattern on an ECG in individuals with syndrome of inappropriate antidiuretic hormone secretion (SIADH) who have syncope symptoms may indicate cardiac issues. A 69-year-old man with hypertension and a history of smoking presented with syncope. His vital signs were within normal limits, with no signs of a neurological deficit. The patient met the diagnostic criteria for SIADH, as evidenced by the presence of hyponatraemia (Na 118 mmol/l), a hyperosmolar condition and euvolemia. Upon arrival, a twelve-lead ECG showed ST-segment anomalies that reflected a Brugada ECG pattern. No ventricular arrhythmias were detected during the 24-hour Holter monitoring. Coronary angiography revealed no abnormalities in the coronary arteries. The ECG demonstrated the normalisation of ST elevations and the disappearance of the Brugada ECG pattern after the correction of hyponatraemia. After three months of follow-up the patient, with a normal sodium level, had no episodes of syncope.

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References

  • Pascual JF, Marchite PJ, Silva JR, Gándara NR. Arrhythmic syncope: from diagnosis to management. World J Cardiol 2023;15:119–141.
  • Francisco-Pascual J, Santos-Ortega A, Roca-Luque I, Rivas-Gándara N, Pérez-Rodón J, Milà-Pascual L, et al. Diagnostic yield and economic assessment of a diagnostic protocol with systematic use of an external loop recorder for patients with palpitations. Rev Esp Cardiol (Engl Ed) 2019;72:473–478.
  • Lindner G, Schwarz C, Haidinger M, Ravioli S. Hyponatremia in the emergency department. Am J Emerg Med 2022;60:1–8.
  • Milionis HJ, Liamia GL, Elisaf MS. The hyponatremic patient: a systematic approach to laboratory diagnosis. CMAJ 2022;166:1056–1062.
  • Brignole M, Moya A, de Lange FJ, Deharo JC, Elliott PM, Fanciulli A, et al. ESC Scientific Document Group. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J 2018;39:1883–1948.
  • Rattanawong P, Senthong V. Hyponatremia induced Brugada syndrome mimicking ST segment elevation myocardial infarction. J Arrhythm 2021;37:1377–1379.
  • Mascia G, Bona RD, Ameri P, Canepa M, Porto I, Parati G, et al. Brugada syndrome and syncope: a practical approach for diagnosis and treatment. Europace 2021;23:996–1002.
  • Hunuk A, Hunuk B, Kusken O, Onur OE. Brugada phenocopy induced by electrolyte disorder: a transient electrocardiographic sign. Ann Noninvasive Electrocardiol 2016;21:429–432.

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    Published: 2024-05-13
    Issue: 2024: Vol 11 No 6 (view)

    How to cite:
    1.
    Rosyidi MA, Valerinna Yogibuana, Ardian Rizal. Syncope and Brugada-like ECG pattern in a patient with syndrome of inappropriate antidiuretic hormone secretion (SIADH). EJCRIM 2024;11 doi:10.12890/2024_004510.