AN UNCOMMON STEMI MASQUERADER: A CASE OF IMIPRAMINE INDUCED BRUGADA PHENOCOPY (BRP)

Brugada syndrome(BrS) is an arrhythmogenic disorder characterized by a bulging ST-segment elevation and a J-point elevation of at least 2 mm in at least two of the right precordial electrocardiogram (ECG) leads (V1-3). It has an incidence of 4 to 12% in sudden cardiac death (SCD) patients due to ventricular tachycardia (VT) or ventricular fibrillation (VF). The Brugada type 1 ECG pattern may occur in various conditions independent of the actual syndrome, and this clinical phenomenon is often referred to as Brugada phenocopy (BrP). A wide variety of other drugs have been reported to unmask or induce Brugada phenotype which may otherwise be concealed, including antianginals, antidepressants, antipsychotics, and antihistamines. In this article, we present a case of Drug-induced BrP due to Imipramine. A 60-year-old hypertensive female patientwith 3 days of chest pain, who was referred to us as possible Acute Coronary Syndrome (ACS) by a general practitioner. She had a history of psychiatric illness and her ECG showed type 1 Brugada pattern with elevation of the J point with an elevation of the curved ST segment in leads V1 to V3. We found that the patient had been taking imipramine for 8 years due to her psychiatric disorder. Psychiatric opinion was sought and drug induced Brugada was suspected following which Imipramine was discontinued. After 2 weeks of follow-up there was resolution of the ST-T changes on the ECG, supporting the diagnosis of drug-induced BrP.