There are a few (eminent) comments appearing on Twitter in favour of CAD (horse) over Brugada (zebra – or is it?)
Features supportive of CAD as the cause are:
- It is (we think) a more common cause of SCD
- There are those lateral ST depressions on the ECG
- His IHD risk factors
Features supportive of possible Brugada are:
- No akinesis/hypokinesis on Echo and structurally normal appearance
- No history of diagnosed IHD or chest pain (although of course that means little)
- The Brugada type 2 morphology
- Story was suggestive of primary syncope vs. chest pain then syncope (some details were slightly altered in my sketch of the history of presenting illness to protect the protagonists – small town!)
- The possible role of Na-channel blocker carbemazepine???
I can’t shed light on some of these points yet – stay tuned!