Brugada phenocopy in fulminant eosinophilic myocarditis: a case series.

IF 0.8 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal: Case Reports Pub Date : 2024-12-02 eCollection Date: 2024-12-01 DOI:10.1093/ehjcr/ytae646
Dai Kawauchi, Kei Yunoki, Tomohiro Yoshino, Takefumi Oka
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Abstract

Background: Brugada phenocopy (BrP) is a condition that induces reversible Brugada-like electrocardiographic (ECG) changes in patients without true Brugada syndrome. We present two cases of fulminant eosinophilic myocarditis that showed Type 1 Brugada ECG changes in the early phase of the clinical course.

Case summary: Case 1 was a 76-year-old man who developed fulminant eosinophilic myocarditis with ventricular tachycardia while hospitalized for heart failure. Case 2 was a 60-year-old man who presented with cardiogenic shock and was diagnosed with fulminant eosinophilic myocarditis. Both patients showed a Type 1 Brugada ECG at onset, and their ventricular function was greatly reduced. Regarding mechanical circulatory support, Case 1 was treated with venous-arterial extracorporeal membrane oxygenation and intra-aortic balloon pumping. Case 2 had venous-arterial extracorporeal membrane oxygenation and Impella CP insertion. Steroid therapy was introduced in both cases. In Case 1, the Type 1 Brugada ECG took 7 days to improve. Left ventricular function improved with time but right heart function was poor and right heart enlargement remained. In Case 2, the Type 1 Brugada ECG improved on the second day, and left and right heart function improved over time.

Discussion: We report two cases of fulminant eosinophilic myocarditis with Brugada-like ECG and severe right heart dysfunction. BrP in acute myocarditis may be an indicator of right heart failure and an important ECG marker in determining the indication for mechanical circulatory support and improvement of right heart function.

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暴发性嗜酸性粒细胞性心肌炎的 Brugada 表征:一个病例系列。
背景:Brugada phenocopy(BrP)是一种在无真正 Brugada 综合征的患者中诱发可逆性 Brugada 样心电图(ECG)改变的疾病。病例摘要:病例 1 是一名 76 岁的男性,在因心力衰竭住院期间患上了伴有室性心动过速的暴发性嗜酸性粒细胞性心肌炎。病例 2 是一名 60 岁的男性,出现心源性休克,被诊断为暴发性嗜酸性粒细胞性心肌炎。两名患者发病时均显示出 1 型 Brugada 心电图,心室功能大大降低。在机械循环支持方面,病例 1 接受了静脉-动脉体外膜氧合和主动脉内球囊泵治疗。病例 2 接受了静脉-动脉体外膜氧合和 Impella CP 植入。两个病例都采用了类固醇治疗。病例 1 的 1 型 Brugada 心电图在 7 天后才有所改善。随着时间的推移,左心室功能有所改善,但右心室功能不佳,右心扩大依然存在。在病例 2 中,1 型 Brugada 心电图在第二天就有所改善,随着时间的推移,左右心功能也有所改善:讨论:我们报告了两例伴有 Brugada 型心电图和严重右心功能不全的暴发性嗜酸性粒细胞性心肌炎病例。急性心肌炎患者的BrP可能是右心功能衰竭的指标,也是确定机械循环支持和改善右心功能指征的重要心电图标志。
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来源期刊
European Heart Journal: Case Reports
European Heart Journal: Case Reports Medicine-Cardiology and Cardiovascular Medicine
CiteScore
1.30
自引率
10.00%
发文量
451
审稿时长
14 weeks
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