A 37-year-old man presents to A&E with pneumonia and a temperature of 39°C. He has no chest pain but a routine ECG is performed.
A. He should be referred for primary angioplasty
This ECG is highly suggestive of Brugada syndrome with a type 1 pattern, i.e. >2 mm ST elevation in the J point, downsloping ST elevation, and inverted T waves best seen in lead V2. The ECG changes can certainly be brought about by fevers, and therefore B is the correct answer. There is no description of syncope and therefore the patient does not meet the criteria for considering an ICD. Ajmaline is not a treatment for Brugada! It is a test for people with type 2 or type 3 Brugada pattern on ECG to provoke a type 1 pattern, but should not be given to people who already have a type 1 pattern as it may provoke dangerous arrhythmias. There is no well-established medical therapy for Brugada syndrome although trials with quinidine are under way.