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COVID-19-induced Brugada phenocopy pattern in a patient with previous myocardial infarction: A case report

Year: 2025

Type: article

Abstract: RATIONALE: Coronavirus disease 2019 (COVID-19) can cause electrocardiographic changes, such as ST-segment elevation, by increasing the dispersion of cardiac repolarization or cause delayed depolarization in a localized area of the right ventricular outflow, leading to clinical misdiagnosis. PATIENT CONCERNS: A 57-year-old man with a history of hypertension and previous myocardial infarction presented to the emergency department with a 12-hour history of fever, chest tightness, and palpitations. DIAGNOSES: An emergency electrocardiogram (ECG) showed sinus rhythm with abnormal Q waves and ST-segment elevation (0.1-0.35 mV) in leads V1-V3. A positive COVID-19 polymerase chain reaction test and specific ECG metrics, including β-angle measurement and r'-wave triangle base duration, led to the diagnosis of a Brugada phenocopy pattern triggered by COVID-19. INTERVENTIONS: The patient was treated with an antiplatelet agent (clopidogrel), an antipyretic (acetaminophen) for fever, and oral antivirals (nimatrelvir/ritonavir). OUTCOMES: After 2 days, his temperature normalized, and a repeat ECG showed resolution of ST-segment elevation. LESSONS: This case highlights the importance of considering fever-induced Brugada phenocopy in the differential diagnosis of ST-segment elevation in patients with coronary artery disease. Careful ECG analysis, including assessment of the β-angle and r'-wave morphology, is crucial to avoid misdiagnosis of ST-elevation myocardial infarction. Initial management should focus on controlling triggering factors such as fever with antipyretics and antivirals to prevent malignant arrhythmias.

Source: Medicine

DOI: 10.1097/md.0000000000046907

Authors: Lijiang Ding, Huayong Jin

Institutions: Shaoxing University, Shaoxing People's Hospital

Language: English

Topic: Cardiac electrophysiology and arrhythmias

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,950