Page 186 - Clinical Pearls in Cardiology

174 Clinical Pearls in Cardiology

It should be remembered that a QS complex, in which
the QRS is entirely negative, can occur in lead V1 and/or
V2 as a normal variant or due to the misplacement of leads
by one intercostal space higher. In such cases, presence
of additional evidences like pathological Q waves and
T inversion in lead V3 also is required to consider a
diagnosis of old anteroseptal myocardial infarction.
25. What is Brugada syndrome?
The Brugada syndrome involves a genetic abnormality
that alters sodium transport in the myocardial cells
and this predisposes to dangerous arrhythmias like
ventricular fibrillation. The syndrome is often familial
(autosomal dominant inheritance). The ST segment
elevation is limited to leads V1 and V2. The ST segment
begins from the top of the R wave and is downsloping,
and it ends with an inverted T wave. The only treatment
is an implanted defibrillator (Fig. 11).

Fig. 11: ECG changes in Brugada syndrome (leads V1 and V2)