2.Case Description
a 23-year-old Caucasian male patient with a long-standing history of substance abuse, presented with a syncope. When EMS arrived, the patient had supraventricular tachycardia around 180 bpm and subsequently cardioverted at 50J on site. They attempted to reverse the patient’s somnolence with Narcan, first intranasal then IV, without improvement. Upon arrival to the emergency department, the patient had a witnessed episode of what appeared to be seizure activity with foaming through the mouth. EKG at the time showed Brugada EKG pattern (Figure 1). He was febrile with a temperature of 103F. Patient’s toxicity profile was positive for both Amphetamine and cannabinoid. Creatine Kinase was >4000 I Unit\L and Troponin I was 2.38 ng\ml which suggested rhabdomyolysis. While hospitalized, the patient had another seizure-like episode while on telemetry, which showed sinus rhythm at time of syncope. Cardiac MRI was negative for structural abnormalities. His family history was significant for SCD in his 40 years-old aunt. We contemplated the idea of placing an implantable cardioverter defibrillator (ICD). However, since he had another seizure while on telemetry without EKG abnormalities, we opted to place an Implantable Loop Recorder (ILR) instead, before discharge.
Figure 1: EKG showing descendent ST-segment elevation with negative T waves (white arrow heads) in the right precordial leads V1 and V2