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ST segment elevation in the precordial leads mimicking Brugada syndrome

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A 58 year old man was referred following the diagnosis of recent onset inferior myocardial infarction (A). Coronary arteriography showed a critical stenosis in the proximal segment of the right coronary artery. Percutaneous transluminal coronary angioplasty (PTCA) was performed to dilate the stenotic lesion. During the first attempt at PTCA, ST segment elevation in leads II, III, aVF, and the precordial leads similar to ECG changes seen in Brugada syndrome were recognised (B). ST elevation was transiently observed during this procedure and thereafter it was not seen in spite of repeated PTCA (C). Although coronary arteriography revealed moderate stenosis in the right ventricular branch before PTCA, it was completely occluded at the end of the session. As the right ventricular branch originated from just before the proximal portion of the stenotic lesion of the right coronary artery, it was considered to be concomitantly exposed to ischaemia during PTCA.

The right ventricular free wall to the outflow tract are important regions in the cause of ST segment elevation similar to Brugada syndrome, regardless of whether the cause is ischaemic or idiopathic.