Lipotimia hides severe illnesses

Introduction: Lipotimia is the alteration of the state of consciousness, that in some cases can be followed by syncope, which is the complete loss of consciousness state. Most often the cause of lipotimia is a benign one, but they mustn’t be neglected because it can lead to the death of the patient.
Case presentation: We will present the case of an young patient, 28 years of age, which had 2 episodes of lipotimia, while at home, 1 week apart. The EKG has shown a minor RBBB with narrow beta angle Chevalier and also a narrow base for the Serra triangle. Those signs were able to be seen after administrating Flecainida i.v. 2mg/kg during 5 minutes, obtaining a typical Brugada syndrome aspect, with an overunity Corrado index. We continued with programmed ventricular stimulation, inducing a rapid monomorphic ventricular tachycardia (200bpm) with a duration of 27 second, duplicating the lipotimia episodes that occurred at home. Thus we formulated the diagnosis of Brugada Syndrome with Ventricular Tachycardia, and we proposed to the patient the implantation of an internal defibrillator. The procedure was temporized by the patient for 5 weeks, during this period he followed a treatment with Chinidina 600 mg/day.
The particularities of the case: The case is interesting from 2 points of view: 1) the clinical manifestation was lipotimia, not syncope or sudden death, as we would have expected in case of a rapid ventricular tachycar-dia. It is well known that in Brugada Syndrome the malign ventricular arrhythmias: VT, VF, spontaneous stop in some cases, with a duration of <30 sec. 2) the second particularity is that the ventriculat tachycardia induced during the cardiac elecrophysiologic study was unsustainable with a duration of 27 sec., but very similar with those that occurred at home. The arrhythmias from at home were also unsustainable, a characteristic particularity of the patients with Brugada Syndome.
Conclusions: Brugada Syndrome is manifesting with ventricular arrhythmias as ventricular tachycardia and ventricular fibrillation. This is clinically manifested with lipotimia, syncope and sudden cardiac death. The treatment consists in implantation of defibrillator to prevent a sudden death, associated or not with Chini-dina.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)