Hyperkalemia-induced Brugada pattern on EKG

Q: What is "hyperkalemic Brugada sign"?

Answer: Type I Brugada type change on EKG with hyperkalemia 

Frequently observed in ICU patients who are extremely acidotic and hyperkalemic, a type I Brugada pattern can be seen on EKG, with a pseudo-right bundle branch block and persistent "coved" ST-segment elevation in at least 2 precordial leads. This is known as the "hyperkalemic Brugada sign".

This should be differentiated from genetic Brugada syndrome by an absence of P waves, marked QRS widening, and/or an abnormal QRS axis. 

#cardiology

#electrolytes

#acidosis

References:

1. Littmann L, Monroe MH, Taylor L 3rd, Brearley WD Jr. The hyperkalemic Brugada sign. J Electrocardiol 2007; 40:53.

2. Doty B, Kim E, Phelps J, Akpunonu P. Pathophysiology of Hyperkalemia Presenting as Brugada Pattern on Electrocardiogram (ECG). Am J Case Rep. 2020 Jul 8;21:e923464. doi: 10.12659/AJCR.923464. PMID: 32636355; PMCID: PMC7370581.

3. Liu R, Chang Q. Hyperkalemia-induced Brugada pattern with electrical alternans. Ann Noninvasive Electrocardiol. 2013 Jan;18(1):95-8. doi: 10.1111/j.1542-474X.2012.00540.x. Epub 2012 Aug 13. PMID: 23347033; PMCID: PMC6932092.