Fainting Spells

Audience: The target audience for this simulation is 4th year medical students, emergency medicine residents, pediatric residents, and family medicine residents. Introduction: Brugada syndrome is defined as the combination of specific electrocardiogram (ECG) changes and clinical manifestations of a ventricular arrhythmia, including syncope and sudden cardiac arrest.1 Brugada syndrome is caused by a mutation in the phase-0 cardiac sodium channel. This mutation can be inherited in an autosomal dominant fashion or it can also occur spontaneously.1,2 This syndrome occurs most frequently in men and is one of the most common causes of sudden cardiac death in Southeast Asian males under the age of 50 with structurally normal hearts.3,4 The classic type I Brugada ECG findings are defined as down-sloping ST segment elevation of >2mm in more than one lead in V1-3, with an associated incomplete or complete right bundle branch block. This mutation can lead to ventricular arrhythmias, most often polymorphic ventricular tachycardia and ventricular fibrillation, resulting in syncope and sudden cardiac death.1,2,3,4,5 These ECG changes are often transient, but can be provoked by a number of factors, including fever and infection, medications, and illicit drugs.6 The treatment for this syndrome is placement of an implanted cardiac cardioverter-defibrillator (ICD) to prevent malignant arrhythmias, treatment of any obvious precipitant, and avoidance of specific medications that are associated with inducing arrhythmias.3 Objectives: By the end of this simulation and debriefing, the learning will be able to: 1) Identify Brugada pattern on ECG; 2) Define Brugada syndrome; 3) Discuss the clinical presentation of Brugada syndrome; 4) List provoking factors that can often precipitate arrhythmia; 5) Review management of adult cardiac arrest; 6) Discuss treatment of Brugada syndrome. Method: High-fidelity medical simulation Topics: Brugada syndrome, syncope, sudden cardiac arrest, ACLS, simulation