Brugada phenocopy induced by heatstroke: a case report

doi:10.3969/j.issn.1674-8115.2025.04.016

Abstract

Abstract:

The patient, a 56-year-old male, was admitted to the emergency department due to confusion and elevated body temperature persisting for 1 d. He presented with multiple organ dysfunction, including coagulation dysfunction, respiratory failure, abnormal liver and kidney function, and gastrointestinal disorders. After excluding other potential causes, a diagnosis of heatstroke was made. Additionally, the patient exhibited myocardial injury and Brugada phenocopy, as evidenced by ST-segment elevation and Brugada wave on electrocardiogram. These findings may be related to several mechanisms such as myocardial thermal injury, systemic inflammatory response after heat stress, and abnormal function of temperator-sensitive ion channels. It is necessary to strengthen the understanding of heatstroke-related myocardial injury and Brugada phenotypy to help improve the treatment and prognosis of heatstroke.

Key words: heatstroke, myocardial injury, ST-segment elevation, Brugada phenocopy

CLC Number:

R594.1

LI Yaomin, XU Jianguo, YU Xia. Brugada phenocopy induced by heatstroke: a case report[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(4): 523-528.

Figures/Tables 4

TrendMD

References 16

1	ROMANELLO M, DI NAPOLI C, GREEN C, et al. The 2023 report of the Lancet Countdown on health and climate change: the imperative for a health-centred response in a world facing irreversible harms[J]. Lancet, 2023, 402(10419): 2346-2394.
2	全军热射病防治专家组, 热射病急诊诊断与治疗专家共识组. 热射病急诊诊断与治疗专家共识(2021版)[J]. 中华急诊医学杂志, 2021, 30(11): 1290-1299.
	Military Heat Stroke Prevention and Control Expert Group, Heat Stroke Emergency Diagnosis and Treatment Expert Consensus Group. Expert consensus on emergency diagnosis and treatment of heat stroke (2021 edition)[J]. Chinese Journal of Emergency Medicine, 2021, 30(11): 1290-1299.
3	BOCK F J, TAIT S W G. Mitochondria as multifaceted regulators of cell death[J]. Nat Rev Mol Cell Biol, 2020, 21(2): 85-100.
4	XIA R, SUN M, LI Y L, et al. The pathogenesis and therapeutic strategies of heat stroke-induced myocardial injury[J]. Front Pharmacol, 2024, 14: 1286556.
5	BAO C H, FENG Q, ZHANG C, et al. Heat stroke with significantly elevated troponin and dynamic ECG changes: myocardial infarction or myocardial injury?[J]. Am J Med Sci, 2024, 368(3): 258-264.
6	张伯翼, 罗雪, 罗珍, 等. 经典型及劳力型热射病大鼠心肌损伤对比研究[J]. 陆军军医大学学报, 2023, 45(17): 1779-1789.
	ZHANG B Y, LUO X, LUO Z, et al. Comparison on myocardial injury in rats with classic versus exertional heat stroke[J]. Journal of Army Medical University,2023, 45(17): 1779-1789.
7	翟羽佳, 徐超, 薛霞, 等. 劳力型热射病患者心电图ST-T异常的临床意义[J]. 中国卫生标准管理, 2021, 12(12): 99-101.
	ZHAI Y J, XU C, XUE X, et al. Clinical significance of electrocardiographic ST-T abnormalities in patients with exertional heat stroke[J]. China Health Standard Management, 2021, 12(12): 99-101.
8	刘娜娜, 王晨霞. 中暑热痉挛并横纹肌溶解误诊为急性心肌梗死剖析[J]. 临床误诊误治, 2017, 30(3): 19-21.
	LIU N N, WANG C X. Analysis of moderate heat spasm meanwhile rhabdomyolysis misdiagnosed as acute myocardial infarction[J]. Clinical Misdiagnosis and Mistreatment, 2017, 30(3): 19-21.
9	AMUSINA O, MEHTA S, NELSON M E. Brugada phenocopy secondary to hyperkalemia and hyponatremia in primary adrenal insufficiency[J]. J Am Coll Emerg Physicians Open, 2022, 3(4): e12800.
10	ELIKOWSKI W, ŁAZOWSKI S, FERTAŁA N, et al. Brugada phenocopy in pulmonary embolism: clinicopathological case study and literature review[J]. Pol Merkur Lekarski, 2022, 50(300): 378-383.
11	LANCINI D, SHETTY R. Tension pneumothorax: a Brugada phenocopy and ST-elevation myocardial infarction mimic[J]. Eur Heart J, 2020, 41(23): 2163.
12	DE OLIVEIRA NETO N R, DE OLIVEIRA W S, MASTROCOLA F, et al. Brugada phenocopy: mechanisms, diagnosis, and implications[J]. J Electrocardiol, 2019, 55: 45-50.
13	BRANCO T, BARBOSA A, CUNHA N, et al. Brugada phenocopy caused by intracranial hemorrhage[J]. Cureus, 2023, 15(3): e35687.
14	DHARANIPRADAB M, VISWANATHAN S, KUMAR G R, et al. Yellow phosphorus-induced brugada phenocopy[J]. J Electrocardiol, 2018, 51(1): 129-131.
15	岳铭慧, 郑佳纯, 朱金秀, 等. 发热引起Brugada综合征的研究进展[J]. 实用心电学杂志, 2019, 28(5): 356-359, 364.
	YUE M H, ZHENG J C, ZHU J X, et al. Research progress in fever-induced Brugada syndrome[J]. Journal of Practical Electrocardiology, 2019, 28(5): 356-359, 364.
16	CANPOLAT U, BAYAZIT Y, AYTEMIR K. Brugada syndrome unmasked by heat exhaustion[J]. Ann Noninvasive Electrocardiol, 2017, 22(1): e12356.

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[6]	SUN Ying, ZHU Ming, ZHANG Jan-wei, et al. Effects of sevoflurane preconditioning and postconditioning on myocardial reperfusion injury under cardiopulmonary bypass in infants [J]. , 2011, 31(9): 1316-.