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