Cocaine-Induced Brugada Pattern.

Background: Brugada phenocopies are clinical entities etiologically distinct from congenital Brugada syndrome; differentiation is crucial for management. Case: A 29 year-old male with a history of cocaine abuse, brought in by Emergency Medical Services (EMS) after he was found unresponsive and given naloxone. He was found altered but arousable with verbal stimuli. He reported snorting a white powder to get “high”. He denied family history of sudden death or previous history of syncope. His ECG on presentation showed coved, ≥2 mm ST elevation with T-wave inversion in V2 consistent with Brugada EKG pattern (Figure 1). His troponin was trending up with elevated creatinine 1.6 mg/dl, liver enzymes and lactic acid, and urine toxicology was positive for cocaine. Decision‐making: The presentation of altered mental status is multifactorial: metabolic derangement, drugs misuse and Brugada. Finding Brugada EKG pattern should be investigated to differentiate congenital Brugada syndrome and Brugada phenocopies. This patient has no family history of sudden death and no prior history of syncope. Serial EKG showed a gradual resolution of the coved and ST elevation in V2. Conclusion: our case demonstrates the importance of careful history taking including family history, as well as serial ECGs and treating the possible underlying etiology such as drugs abuse or electrolytes abnormality. It is also warranted to differentiate between Brugada phenocopies from congenital Brugada syndrome because therapeutic strategies are quite different with each diagnosis.