ABSTRACT
BACKGROUND: Pharmacologic challenge test is often used to diagnose Brugada syndrome (BrS) when spontaneous electrocardiograms (ECG) do not show type I Brugada pattern but reported sensitivity varies. The role of the exercise stress test in diagnosing Brugada syndrome is not well-established. CASE SUMMARY: A patient had a type I Brugada pattern ECG during the recovery phase of exercise stress test but had a negative procainamide challenge test. He had a loop recorder implanted and later survived a ventricular fibrillation (VF) arrest provoked by coronavirus disease 2019 (COVID-19). Electrocardiogram on arrival showed type 1 Brugada pattern. He was discharged after implantable cardioverter-defibrillator implantation. He later underwent genetic testing and was found to be heterozygous for c.844C>G (p.Arg282Gly) mutation in the SCN5A gene. DISCUSSION: Type 1 Brugada pattern ECG may be unmasked by ST-segment augmentation during recovery from exercise. Exercise stress test may play a role in the diagnosis of Brugada syndrome when suspicion for Brugada syndrome remains after a negative procainamide challenge test or if the patient has exercise-related symptoms. COVID-19 can unmask BrS and trigger a VF cardiac arrest.
ABSTRACT
Introduction ST-elevation myocardial infarction (STEMI) is a serious manifestation of coronary artery disease and remains a significant contributor to morbidity and mortality worldwide. To reduce the risk of recurrent cardiovascular disease (CVD) events, the American College of Cardiology (ACC) and American Heart Association (AHA) recommend the use of five classes of medications after acute coronary syndrome (ACS). The purpose of this study was to evaluate whether STEMI patients admitted to our community hospital were discharged on optimal medical therapy based on the latest AHA/ACC guidelines. Methods A retrospective, single-center electronic medical records review was conducted at our community hospital between July 2017 and December 2018. Patients included in the study were admitted to our hospital through the emergency department as STEMI alerts. We reviewed the discharge prescriptions and assessed compliance with the medication regimen endorsed by AHA/ACC, which includes aspirin, P2Y12 inhibitors, ß-blockers, angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), and statins. Results A total of 147 patients were included in our study. The mean age of our study population was 62 ± 12.48 years. 97.2% of all patients with STEMI underwent coronary angiography. Hypertension (65.9%) was the most common comorbidity followed by hyperlipidemia (54.42%), diabetes mellitus (29.25%), and history of coronary artery disease (CAD) (24.48%). Among patients with successful reperfusion, 87.4% of the patients received the combination of four guideline-directed medical therapy (GDMT) (comprising dual antiplatelet therapy, a ß-blocker, and a statin) and 57% were discharged on five guideline-directed medical treatment (the combination of dual antiplatelet therapy, a ß-blocker, an ACEIs or an ARB, and a statin). Conclusion Optimal secondary prevention medications are known to be effective in reducing the risk of repeat ischemic events in ACS. This study demonstrated that adherence to GDMT in our community-based hospital study is better compared to prior studies but remained suboptimal. Potential strategies to improve adherence to guidelines are necessary.
