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Introduction: ST changes and chest pain are a scary and deadly combination. Most of the time they require urgent heart catheterization. However, Brugada syndrome can present with similar features and involves a different approach. We present a patient with typical chest pain and ECG showing possible STEMI who was diagnosed with Brugada syndrome.

Case description: Patient is a 46-year-old man with hypertension and smoking, who presented at emergency department complaining of anterior chest pain, sharp, radiating to left arm associated with dizziness and palpitations. His wife told that two weeks prior, she found him lying on the floor drooling, confused and with noisy breathing. At emergency department his blood pressure was 154 over 94 mmHg, oxygen saturation 98%. Troponin was negative. Initial ECG showed ST elevation in leads V1 to V3. Echocardiogram did not show wall motion abnormalities or decreased ejection fraction. Exercise stress test negative for ischemia and coronary tomography was normal. Electrophysiology exam negative for ventricular tachycardia or ventricular fibrillation. A final diagnosis of Brugada syndrome was made and patient had an implanted defibrillator placed.

Conclusion: Brugada syndrome is an autosomal dominant channelopathy responsible for 4-12% of all sudden cardiac deaths in the world. The most common mutation occurs in the gene SCN5A and family members screening is mandatory. There are three types of Brugada ECG, but only type I is considered diagnostic. Treatment consists in the implant of a cardiac defibrillator, even though novel therapies involving ablation are emerging.

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