Diagnosis: Brugada Syndrome

We describe a 29-year-old man who presented to our emergency department (ED) with chest pain and features of Brugada syndrome on ECG, but the diagnosis was only made after his third visit to the ED. It is important to shed the light on this rare but important syndrome since it affects young people and when diagnosed, treatment options to prevent sudden cardiac death are highly successful. Brugada syndrome is one of the causes of sudden cardiac death in the young with no structural heart abnormalities. The current prevalence is estimated to be 0.4% to 0.6% in western countries, but a higher frequency may be found in Far East countries like Thailand.1,2 The syndrome has a characteristic pattern on resting ECG, but some times a provocative test needs to be done to demonstrate the abnormality. First described by Pedro and Joseph Brugada in 1992, Brugada syndrome is an autosomally dominant inherited cardiac disease with variable expression, resulting from mutation in the SCN5A gene, causing life-threatening polymorphic ventricular arrhythmia in a patient who is otherwise healthy. Men are more commonly affected than women. Sudden death happens usually while sleeping and is the presenting symptom of one third of patients, and is not related to exercise.3 The