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. 2010 Jul 6;2(3):e147-e150.
doi: 10.1016/j.jccase.2010.05.011. eCollection 2010 Dec.

Brugada-type electrocardiogram in a patient with hypothyroidism

Kayano Taira  1 , Akihisa Fujino  1 , Tatsuya Watanabe  1 , Atsuhiro Ogyu  1 , Kouichi Ashikawa  1 , Wataru Shimizu  2
Affiliations

Brugada-type electrocardiogram in a patient with hypothyroidism

Kayano Taira et al. J Cardiol Cases. .

Abstract

We encountered a case of hypothyroidism showing Brugada-type electrocardiogram (ECG). A 52-year-old man was referred to our hospital in August 2009. Past medical history showed that liver dysfunction and face edema of unknown origin had been pointed out 1 year earlier. He was diagnosed with primary hypothyroidism at this admission. ECG exhibited first-degree atrio-ventricular block (0.24 s) and showed Brugada-type ST-segment elevation ≥2 mm followed by a negative T wave (coved type) in the V1, V2 leads. On genetic analysis, the patient demonstrated three common variants in the SCN5A gene, L1988R (c.5963 T>G), H558R (c.1673 A>G), and R1193Q (c.3578 G>A). Brugada-type ECG disappeared when the thyroid function normalized. We hypothesize that Brugada-type ECG in hypothyroidism is modified not only by a direct effect of thyroid hormone, but also due to SCN5A variants. Some SCN5A gene polymorphisms or mutations will induce changes on ECG when ion channels are affected by hypothyroidism.

Keywords: Brugada-type ECG; Hypothyroidism; Late potential; SCN5A genes.

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Figures

Figure 1
Figure 1
Electrocardiogram and signal-averaged electrocardiogram on admission. RMS(40), root mean square voltage of the terminal 40 ms in the filtered QRS complex; LAS(40), duration of low amplitude signals <40 μV in the terminal filtered QRS complex; fQRS, duration of the filtered QRS.
Figure 2
Figure 2
Clinical course. AST, aspartate transaminase; ALT, alanine transaminase; LDH, lactate dehydrogenase; γGTP, γ-glutamyl transpeptidase; CK, creatine kinase; TSH, thyroid stimulating hormone.
Figure 3
Figure 3
The electrocardiogram changed again to Brugada type after administration of the class Ic anti-arrhythmic drug, pilsicainide.
See this image and copyright information in PMC

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