Bonjour docteur. Il y a deux ans, suite à des perfusion d’immunoglobuline sur 3 jours, sans hydratation " ce qui est une faute grave, car les immunoglobulines épaississent le sang, j'ai eu 15 jours apres une autre perfusion sur 5 j avec une bonne hydratation. Gros problème 6 Jours apres? Une grosse détresse respiratoire.3 semaines apres, j'ai un ECG en forme d'aileron de requin. La forme est semblable à votre dessin du Brugada, mais l'ensemble du QRS à disparue, avalé pas l'ischémie selon Pierre Taboulet. Depuis 3 semaines le Cardiologue à qui je demande des explications sut mon ECG queue de requin, a disparue. Il ne veux pas me répondre. J'ai bien l'impression que je me suis choppé un Infarctus? Merci pour votre retour. Patrick Dupré
+mostafa alalwan - THANKS for the positive feedback. Note that I will very shortly complete a LINKED CONTENTS to this Video, that should facilitate rapid access to specific parts of the presentation (GO TO - ecg-interpretation.blogspot.com/p/c-lick-h-ere-to-get-back-to-my-ecg-blog_16.html ).
This is an amazing and excellent explanation of brugada! It’s the most detailed explanation video on the internet for sure. This will help in many clinical settings and students like myself a lot. Just one question: does confirmatory type 2 brugada criteria involve more than one leads (V1-V3)? If saddleback morphology is only found in one single lead, say V1, but not V2 or V3, does that fit the criterion for type 2?
@ GZ - Thanks so much for the positive feedback! Please be SURE that you have looked at my notes for this video (Click on SHOW MORE under the Video) - especially the Addendum I added on 10/24/2020, as the way Brugada-1 is defined has changed since I made this video. Other than that - the video remains current. As to your question - yes, you can diagnose a Brugada-2 (Saddleback) morphology from a single lead - but remember that a Brugada-2 pattern is only suggestive of the possibility of Brugada Syndrome, and it is in no way by itself diagnostic. THANKS again for your positive feedback! - :)
Thank you for your answer and detailed response Dr. Grauer! It is greatly appreciated. Just to clarify your answer, I read on Dr. Smith’s ECG Blog, that once the brugada saddleback morphology is fulfilled in V1 and/or V2, that in order to confirm a brugada type 2 pattern in its entirety, there “should be, in lead V2” - to quote Dr. Smith: 1. High take-off of the descending limb of the r' at least 2 mm above the isoelectric line (in our case, it is greater than 2 mm). The r'-wave is thus not distinct, as it is in benign causes of rSr' 2. Mismatch between QRS duration in leads V1 and V6 (longer in lead V1). This helps to distinguish from RBBB, in which the QRS duration is equal in V1 and V6. 3. As with Type 1, the peak of the r'-wave does not correspond to the J-point in other leads. 4. The base of the triangle outlined should be longer than 3.5 mm. This confirms that the slope of the ST segment is flat enough for the diagnosis. If these morphologies are not present in V2, but a brugada saddleback morphology was present in V1, then is the ECG still suggestive of brugada pattern type 2 in its entirety? My general understanding was that saddleback pattern is more often seen in V2, but if it’s seen in V1, then V2 must also fill that specific criteria for a confirmatory Type 2 pattern, thus requiring more than one lead to confirm BrP Type 2 if the pattern is only seen in lead V1. Thank you for your time and expertise.
Great talk. I would like to invite you to talk about this presentation in our Website at www.brugadaphenocopy.com and eventually insert a link. Congratulations!!!! Adrian Baranchuk MD FACC FRCPC
+Adrian Baranchuk - Hi Adrian. So SORRY for my delay in answering your comment (I was traveling and away from email contact). Your Brugada Phenocopy web site looks excellent! What did you have in mind re talking about my presentation? THANKS again for your kind comment - which means a LOT coming from you with all your expertise in this area! - :)
Very simplified.thanks a lot sir
THANK YOU for the kind words - :)
Presentation is very much impressive & helpful to me.Thanks a lot sir..🙂
Thank you for another informative presentation.
i find this material very helpfull the content is very extense and the way that you describe things is very educational . thanks
Thank you Patricia! - :)
Bonjour docteur. Il y a deux ans, suite à des perfusion d’immunoglobuline sur 3 jours, sans hydratation " ce qui est une faute grave, car les immunoglobulines épaississent le sang, j'ai eu 15 jours apres une autre perfusion sur 5 j avec une bonne hydratation. Gros problème 6 Jours apres? Une grosse détresse respiratoire.3 semaines apres, j'ai un ECG en forme d'aileron de requin. La forme est semblable à votre dessin du Brugada, mais l'ensemble du QRS à disparue, avalé pas l'ischémie selon Pierre Taboulet. Depuis 3 semaines le Cardiologue à qui je demande des explications sut mon ECG queue de requin, a disparue. Il ne veux pas me répondre. J'ai bien l'impression que je me suis choppé un Infarctus? Merci pour votre retour. Patrick Dupré
Thank you very much sir for excellent and unique lecture , we appreciate your efforts for simplifying Brugada Syndrome :)
+mostafa alalwan - THANKS for the positive feedback. Note that I will very shortly complete a LINKED CONTENTS to this Video, that should facilitate rapid access to specific parts of the presentation (GO TO - ecg-interpretation.blogspot.com/p/c-lick-h-ere-to-get-back-to-my-ecg-blog_16.html ).
thanks a lot professor
thank You very much sir
Thanks for your interest. I updated this video here - Blog #238 - tinyurl.com/KG-Blog-238 - :)
that was an awesome explanation. thank u so much sir!
This is an amazing and excellent explanation of brugada! It’s the most detailed explanation video on the internet for sure. This will help in many clinical settings and students like myself a lot. Just one question: does confirmatory type 2 brugada criteria involve more than one leads (V1-V3)? If saddleback morphology is only found in one single lead, say V1, but not V2 or V3, does that fit the criterion for type 2?
@ GZ - Thanks so much for the positive feedback! Please be SURE that you have looked at my notes for this video (Click on SHOW MORE under the Video) - especially the Addendum I added on 10/24/2020, as the way Brugada-1 is defined has changed since I made this video. Other than that - the video remains current. As to your question - yes, you can diagnose a Brugada-2 (Saddleback) morphology from a single lead - but remember that a Brugada-2 pattern is only suggestive of the possibility of Brugada Syndrome, and it is in no way by itself diagnostic. THANKS again for your positive feedback! - :)
Thank you for your answer and detailed response Dr. Grauer! It is greatly appreciated. Just to clarify your answer, I read on Dr. Smith’s ECG Blog, that once the brugada saddleback morphology is fulfilled in V1 and/or V2, that in order to confirm a brugada type 2 pattern in its entirety, there “should be, in lead V2” - to quote Dr. Smith:
1. High take-off of the descending limb of the r' at least 2 mm above the isoelectric line (in our case, it is greater than 2 mm). The r'-wave is thus not distinct, as it is in benign causes of rSr'
2. Mismatch between QRS duration in leads V1 and V6 (longer in lead V1). This helps to distinguish from RBBB, in which the QRS duration is equal in V1 and V6.
3. As with Type 1, the peak of the r'-wave does not correspond to the J-point in other leads.
4. The base of the triangle outlined should be longer than 3.5 mm. This confirms that the slope of the ST segment is flat enough for the diagnosis.
If these morphologies are not present in V2, but a brugada saddleback morphology was present in V1, then is the ECG still suggestive of brugada pattern type 2 in its entirety? My general understanding was that saddleback pattern is more often seen in V2, but if it’s seen in V1, then V2 must also fill that specific criteria for a confirmatory Type 2 pattern, thus requiring more than one lead to confirm BrP Type 2 if the pattern is only seen in lead V1.
Thank you for your time and expertise.
Thanks professor Grauer. Invaluable teaching points we should remember. chapau. H Munoz, MD Caracas, Venezuela.
Glad my video was helpful! - :)
Thank you so much for your video, sir!
waw
Great talk. I would like to invite you to talk about this presentation in our Website at www.brugadaphenocopy.com and eventually insert a link. Congratulations!!!! Adrian Baranchuk MD FACC FRCPC
+Adrian Baranchuk - Hi Adrian. So SORRY for my delay in answering your comment (I was traveling and away from email contact). Your Brugada Phenocopy web site looks excellent! What did you have in mind re talking about my presentation? THANKS again for your kind comment - which means a LOT coming from you with all your expertise in this area! - :)
I am a cardio tech at a local hospital here in Nanaimo, BC. I am quickly becoming a fan of your channel and content. You are an excellent teacher.
Thank you so much for the kind words! - :)
Fantaaaastic
Thank you - :)