Utility of right precordial leads
at higher intercostal space positions to diagnose Brugada syndrome.
His electrocardiogram remained abnormal, with T-wave inversion on the precordial leads
and disappearance of the ST-segment abnormalities.
Brugada syndrome was first described in 1992 as a new autosomal dominant inherited channelopathy occurring in the structurally normal heart, characterized by ST-segment elevation in the right precordial leads
, right bundle branch block, and susceptibility to ventricular tachyarrhythmia's (1).
Electrocardiographic criterion for right ventricular infarction in inferior MI was defined asthe presence of [greater than or equal to]l mm ST-segment elevation at the right precordial lead
V4R of electrocardiogram according to American Heart Association scientific statement on acute ischemia/infarction (3).
Baseline ECG revealed a right bundle branch block, inverted T waves in the anterior precordial leads
, and epsilon waves (low amplitude signals between the end of the QRS complexes and the onset of the T waves; see arrows) (Figure 1).
An electrocardiogram now showed deep T-wave inversions in the precordial leads
The electrocardiogram showed low voltage in the precordial leads
The initial 12-lead electrocardiogram showed sinus rhythm with 2:1 AV block, right bundle branch block, left anterior fascicular block, and ST-segment depression in precordial leads
V1 to V3 (Figure 1).
Incomplete right bundle branch block and ST-T wave abnormalities in precordial leads
as in our patient can be seen as the ECG changes (1,2, 7).
The Table lists many of the causes of tall R waves in the right precordial leads
and confirming clues to their diagnoses (1).
The following criteria were used for the diagnosis of STEMI: chest pain for more than 20 min and ST segment elevation more than 1 mm in at least two standard limb leads or 2 mm in at least two contiguous precordial leads
Since akinesis may be due to hibernation rather than infarction, patients were included only if Q waves were present in at least two anterior leads or if there was poor or reverse R-wave progression in the anterior precordial leads
Perhaps the most interesting and least appreciated aspect of the electrocardiogram is the low QRS voltage in the limb leads in the presence of high QRS voltage in the precordial leads
Brugada syndrome (BS) is characterized by right bundle branch block (RBBB) pattern with ST-segment elevation in right precordial leads
and a propensity for sudden cardiac death due to ventricular arrhythmias.
Tweve inversion in the precordial leads
is the most common repolarization abnormality.