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病例分享：见到这种心电图，警惕Brugada综合征与猝死风险

2018-02-12 江苏省人民医院 卢妙 许迪 黄元铸 中国医学论坛报今日循环

心电图Brugada综合征猝死
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35岁男性，1小时前发作晕厥1次，目前无明显不适症状。

35岁男性，1小时前发作晕厥1次，目前无明显不适症状。



心电图解析与诊断

1.窦性心律；2.心率74次/分；3.不完全RBBB；4.V1、V2导联ST段下斜型抬高。

诊断与评述

1.该心电图表现为不完全RBBB和右心导联V1-V2导联ST段下斜型抬高，符合Brugada综合征。

2.Brugada兄弟在1992年首次将Brugada综合征描述为心脏结构正常的患者猝死的常见原因。其特征为完全性或不完全性RBBB伴V1−V3导联ST段抬高（有时仅出现在V1、V2导联），ST段抬高通常呈下斜型或马鞍形。此类患者易发生室性心动过速，尤其是多形性室速（如果室速持续，则会导致猝死，如果室速能自终止，则引起晕厥）。若心电图考虑Brugada综合征，则应进一步行电生理学检查以明确诊断。由于患者易发生猝死，Brugada综合征唯一有效的治疗方法是植入ICD。如果不植入ICD，死亡率约为10%/年。

3.该患者经电生理检查确诊Brugada综合征，植入ICD后出院，目前在随访中。

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authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Mon Feb 12 15:46:24 CST 2018, time=2018-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=287379, encodeId=f73728e379cb, content=学习了.涨知识了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDM9swhbgTo7nzqRKzMmzckmEoeTyLQVDCgjqsicjyhxPs0vPoYU6GsSYbCjSkNHicJkz3NL0a0EbUMVdNjkctXI6FocpGKaVr9E/0, createdBy=29392048316, createdName=王秀, createdTime=Mon Feb 12 15:19:35 CST 2018, time=2018-02-12, status=1, ipAttribution=)]
    2018-08-26 仁心济世

    #Brugad#

    0

  2. 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authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Mon Feb 12 15:46:24 CST 2018, time=2018-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=287379, encodeId=f73728e379cb, content=学习了.涨知识了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDM9swhbgTo7nzqRKzMmzckmEoeTyLQVDCgjqsicjyhxPs0vPoYU6GsSYbCjSkNHicJkz3NL0a0EbUMVdNjkctXI6FocpGKaVr9E/0, createdBy=29392048316, createdName=王秀, createdTime=Mon Feb 12 15:19:35 CST 2018, time=2018-02-12, status=1, ipAttribution=)]
    2018-02-18 changjiu

    学习一下谢谢

    0

  3. 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authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Mon Feb 12 15:46:24 CST 2018, time=2018-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=287379, encodeId=f73728e379cb, content=学习了.涨知识了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDM9swhbgTo7nzqRKzMmzckmEoeTyLQVDCgjqsicjyhxPs0vPoYU6GsSYbCjSkNHicJkz3NL0a0EbUMVdNjkctXI6FocpGKaVr9E/0, createdBy=29392048316, createdName=王秀, createdTime=Mon Feb 12 15:19:35 CST 2018, time=2018-02-12, status=1, ipAttribution=)]
    2018-02-14 changjiu

    学习一下谢谢

    0

  4. 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    2018-02-14 般若傻瓜

    #ADA#

    0

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authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Mon Feb 12 15:46:24 CST 2018, time=2018-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=287379, encodeId=f73728e379cb, content=学习了.涨知识了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDM9swhbgTo7nzqRKzMmzckmEoeTyLQVDCgjqsicjyhxPs0vPoYU6GsSYbCjSkNHicJkz3NL0a0EbUMVdNjkctXI6FocpGKaVr9E/0, createdBy=29392048316, createdName=王秀, createdTime=Mon Feb 12 15:19:35 CST 2018, time=2018-02-12, status=1, ipAttribution=)]
    2018-02-14 zhouqu_8

    #综合征#

    0

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authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Mon Feb 12 15:46:24 CST 2018, time=2018-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=287379, encodeId=f73728e379cb, content=学习了.涨知识了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDM9swhbgTo7nzqRKzMmzckmEoeTyLQVDCgjqsicjyhxPs0vPoYU6GsSYbCjSkNHicJkz3NL0a0EbUMVdNjkctXI6FocpGKaVr9E/0, createdBy=29392048316, createdName=王秀, createdTime=Mon Feb 12 15:19:35 CST 2018, time=2018-02-12, status=1, ipAttribution=)]
    2018-02-14 ms3323097325231039

    #猝死风险#

    0

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attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=939917859602, createdName=nymo, createdTime=Wed Feb 14 05:44:00 CST 2018, time=2018-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=287648, encodeId=998628e648f7, content=心电图考虑Brugada综合征.则应进一步行电生理学检查以明确诊断, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJUlbw1Mf1vppicGcaWPx1YUOgLgKccao77Rykbx3jiazqzwcyXMdzRIZkhFyBPqknibeuOGhXI1VzVg/0, createdBy=7f162154630, createdName=沙漠浪人, createdTime=Tue Feb 13 16:02:40 CST 2018, time=2018-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=287383, encodeId=bf9c28e383e0, content=好文章.学习了., beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Mon Feb 12 15:46:24 CST 2018, time=2018-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=287379, encodeId=f73728e379cb, content=学习了.涨知识了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDM9swhbgTo7nzqRKzMmzckmEoeTyLQVDCgjqsicjyhxPs0vPoYU6GsSYbCjSkNHicJkz3NL0a0EbUMVdNjkctXI6FocpGKaVr9E/0, createdBy=29392048316, createdName=王秀, createdTime=Mon Feb 12 15:19:35 CST 2018, time=2018-02-12, status=1, ipAttribution=)]
    2018-02-14 nymo

    #Brugada#

    0

  8. 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authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Mon Feb 12 15:46:24 CST 2018, time=2018-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=287379, encodeId=f73728e379cb, content=学习了.涨知识了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDM9swhbgTo7nzqRKzMmzckmEoeTyLQVDCgjqsicjyhxPs0vPoYU6GsSYbCjSkNHicJkz3NL0a0EbUMVdNjkctXI6FocpGKaVr9E/0, createdBy=29392048316, createdName=王秀, createdTime=Mon Feb 12 15:19:35 CST 2018, time=2018-02-12, status=1, ipAttribution=)]
    2018-02-13 沙漠浪人

    心电图考虑Brugada综合征.则应进一步行电生理学检查以明确诊断

    0

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authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Mon Feb 12 15:46:24 CST 2018, time=2018-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=287379, encodeId=f73728e379cb, content=学习了.涨知识了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDM9swhbgTo7nzqRKzMmzckmEoeTyLQVDCgjqsicjyhxPs0vPoYU6GsSYbCjSkNHicJkz3NL0a0EbUMVdNjkctXI6FocpGKaVr9E/0, createdBy=29392048316, createdName=王秀, createdTime=Mon Feb 12 15:19:35 CST 2018, time=2018-02-12, status=1, ipAttribution=)]
    2018-02-12 1e0f8808m18(暂无匿称)

    好文章.学习了.

    0

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authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Mon Feb 12 15:46:24 CST 2018, time=2018-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=287379, encodeId=f73728e379cb, content=学习了.涨知识了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDM9swhbgTo7nzqRKzMmzckmEoeTyLQVDCgjqsicjyhxPs0vPoYU6GsSYbCjSkNHicJkz3NL0a0EbUMVdNjkctXI6FocpGKaVr9E/0, createdBy=29392048316, createdName=王秀, createdTime=Mon Feb 12 15:19:35 CST 2018, time=2018-02-12, status=1, ipAttribution=)]
    2018-02-12 王秀

    学习了.涨知识了!

    0

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