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Brugada syndrome

The Brugada syndrome is a genetic disease that is manifest by abnormal electrocardiogram (ECG) findings and an increased risk of sudden cardiac death. It is also known as Sudden Unexpected Death Syndrome1 (SUDS), and is the most common cause of death in the young in Thailand and Laos2. more...

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First described in 19923, the Brugada syndrome causes sudden death by causing ventricular fibrillation (a lethal arrhythmia) in the heart.

Genetics and pathophysiology

Brugada syndrome is due to a mutation in the gene that encodes for the sodium ion channel in the cell membranes of the muscle cells of the heart (the myocytes). The gene, named SCN5A, is located on the short arm of the third chromosome (3p21). This condition is inherited in an autosomal dominant pattern.

Electrocardiography

In some cases, the disease can be detected by observing characteristic patterns on an electrocardiogram, which may be present all the time, or might be elicited by the administration of particular drugs. The pattern seen on the ECG is persistent ST elevations in the electrocardiographic leadsV1-V3 with a right bundle branch block (RBBB) appearance with or without the terminal S waves in the lateral leads that are associated with a typical RBBB. A prolongation of the PR interval (a conduction disturbance in the heart) is also frequently seen.

Treatment

The cause of death in Brugada syndrome is ventricular fibrillation. While there is no treatment modality that prevents ventricular fibrillation from occurring in this syndrome, treatment lies in termination of this lethal arrhythmia before it causes death. This is done via implantation of an implantable cardioverter-defibrillator (ICD), which continuously monitors the heart rhythm and will defibrillate an individual if ventricular fibrillation is noted.

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Electrocardiography. 5th ed
From Critical Care Nurse, 12/1/04 by Linda Bell

Electrocardiography. 5th ed.

Mosby's Pocket Guide Series. Mary Boudreau Conover, St. Louis, Mo: Mosby: 2004.

337 pages; $26.95.

This pocket sized reference is composed of 31 chapters--each devoted to a different aspect of electrocardiography (ECG). Each chapter is relatively short and packed with easy-to-use reference information and illustrations. As with previous books by Conover, this volume provides the appropriate level of information for the target audience.

[ILLUSTRATION OMITTED]

Electrocardiography begins with the basics of monitoring and 12-lead ECG placement; then proceeds through the normal cardiac electrical information and mechanisms of arrhythmias. The classic information of ECG analysis is addressed, that is, systematic evaluation of waveforms and determination of axis.

The arrhythmia sections are devoted to single topics such as atrial fibrillation and flutter and continue on to ventricular ectopy. Topics of interest to anyone evaluating ECG rhythms are included, such as aberration versus ectopy, drug-and electrolyte-induced changes, and specific changes that can be expected in the athlete or during cardiac-related conditions. Additions to this edition are The Athlete's ECG, Congenital Long QT Syndrome, and Brugada Syndrome.

This book would be of value to anyone needing a quick reference at hand, whether he or she is working in a cardiac unit and sees frequent challenging arrhythmias, or is a less sophisticated user needing a helpful resource.

Electrocardiography is not a reference for in-depth analysis; there are many resources available on the market for that purpose. This is the quick reference, something that can be carried in the pocket of a scrub jacket or lab coat, and that will assist in the immediate analysis of ECG rhythms. It will be as helpful for the nurse or monitor technician new to the world of ECG analysis as to the advanced practitioner needing a teaching tool. For example, each arrhythmia analysis section includes a rhythm strip with a brief description, ECG recognition criteria, the mechanism of the arrhythmia (including illustrations as appropriate), clinical implications, emergency and long-term treatment, and patient education requirements. Additional information that would have been helpful is the documentation and additional monitoring requirements.

Reviewed by Linda Bell, RN, MSN

Linda Bell is a Clinical Practice Specialist at the American Association of Critical-Care Nurses in Aliso Viejo, Calif.

COPYRIGHT 2004 American Association of Critical-Care Nurses
COPYRIGHT 2004 Gale Group

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