Brugada Syndrome Accompanied with Coronary Heart Disease

Brugada syndrome is an inherited disorder of ion channels in cardiomyocytes, and most common are mutations in the SCN5A gene. It is characterized by specifi c features on ECG, can cause syncope and sudden cardiac death due to ventricular arrhythmias (13). Most patients have no structural changes in the heart or they are minimal, but cases of coexisting signifi cant coronary heart disease, as well as ischemia-induced Brugada-like ECG features have been described (1,2,4,5). Th e diagnosis of Brugada syndrome is based on specifi c spontaneous ECG features or features occurring during test performance with sodium channel blockers application (e.g., ajmaline, procainamide, fl ecainide) (2). Brugada syndrome was fi rst described more than 25 years ago. Th e defi nition and ECG diagnostic criteria have changed over time; today, we distinguish three types of ECG features, as follows: type 1 is diagnostic and consists of concave elevation of the ST-segment and J point by >2 mm at its peak, followed by negative T-wave with little or no isoelectric separation in one or more right precordial leads (V1 and V2); type 2 consists of high ST-segment elevation aft er J point (2 mm), which is followed by gradual descending ST-segment elevation (1 mm above the baseline), and positive or biphasic T wave, saddle confi guration; and type 3 has a saddle or concave elevation of the ST segment of <1 mm in the right precordial leads (1). Th e use of an implantable cardioverter defi brillator is eff ective therapeutic choice for prevention of sudden cardiac death due to arrhythmias (6). Although this syndrome typically manifests with arrhythmia and syncope episodes in younger age (1,2), we report a case of coexistence of two diff erent heart conditions, Brugada syndrome and coronary heart disease in a 60-year-old patient.