Drug Overdose Leading to Unmasking of Brugada Syndrome

Brugada syndrome (BrS) is a cardiac autosomal dominant disorder characterized by a constellation of typical electrocardiogram findings as well as clinical criteria including ventricular tachyarrhythmias and sudden death. Although many cases of BrS have been documented, few have identified a drug-induced mechanism as the basis of unmasking the underlying genetic disorder. We present a unique case of a 44-year-old female that was admitted for workup of altered mentation. Upon expanded history, it was evident that multiple psychoactive medications, including amitriptyline, lithium, venlafaxine, and diazepam, taken in duplicity, may have resulted in the observed encephalopathy, and more interestingly, resulted in the unmasking of an underlying BrS with typical electrocardiogram (EKG) changes. Notably, these EKG changes largely reverted to an expected baseline with the cessation of the culprit medications, inferring that drug-induced BrS is a rare but real entity with important implications. This case illustrates that early identification of susceptible individuals creates opportunity for expedited intervention and strategies to screen for familial inheritance to avert lethal arrhythmias and sudden cardiac death. Moreover, as suspected prescription medications become better studied and characterized, informed decision-making can take place to optimize therapeutic management of psychiatric and cardiac comorbidities. J Med Cases. 2018;9(6):179-182 doi: https://doi.org/10.14740/jmc3068w