Hyperkalemia and cocaine induced dynamic Brugada-type electrocardiogram

Brugada syndrome is a well-defined clinical entity with the typical electrocardiographic changes in the right precordial leads (V1 and V2), attributed to mutation in SCN5A gene. Brugada-like electrocardiographic pattern can be replicated by sodium channel-blocking drugs and electrolyte abnormalities. We describe a 46-year-old individual, who presented with hyperkalemia secondary to muscle damage and renal insufficiency, after abusing cocaine. The electrocardiogram showed Brugada sign. The electrocardiogram changes disappeared after sodium bicarbonate administration and normalization of serum potassium. The case highlights the importance of recognizing cocaine and hyperkalemia, as potential triggers of the acquired Brugada sign. European Journal of Emergency Medicine 17: 113-115 (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.