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A 59 year old woman presented with chest pain radiating to the left arm and accompanied by dyspnoea and sweating. Her symptoms began at 2:30 am. Upon arrival, the ECG showed saddleback ST segment elevations in leads V1–V3. The diagnosis of acute myocardial infarction was made and the patient was transferred to the regional centre for primary angioplasty. Coronary angiography revealed an occlusion in the proximal segment of the left anterior descending artery (upper panels). The pain to balloon time was five hours. Cardiac markers were raised (creatine kinase (CK) 1547 U/l, CK-MB 375 U/l). ST segment elevations changed from saddleback to coved (lower panels) with slow resolution during the first week. Neither the patient nor her family had had any signs or symptoms of Brugada syndrome.
This case illustrates that not only can Brugada syndrome be mistaken for acute myocardial infarction but that the reverse may also occur.