This report demonstrates the first case of inferior phenotype variant Brugada Pattern (BP) as the presenting sign of Propofol Infusion Syndrome (PRIS). A 65-year-old male in respiratory failure receiving four consecutive days of high dose propofol developed ST elevations, hyperkalemia, and lactatemia. ST elevations noted were sharply down-sloping presenting in inferior leads.1 Hyperkalemia was treated and propofol discontinued. This therapy resulted in improvement in EKG and favorable outcome. This case supports three conclusions: the existence of inferior variant BP, BP may be a strong initial sign of PRIS, and early recognition and action stopping propofol leads to favorable outcome in PRIS.1-4
Propofol Infusion Syndrome (PRIS), once thought only to occur in children, has gained popularity in recent years due to its high morbidity and mortality in adults as well. Due to heightened awareness and detection bias, the incidence of PRIS is increasing. The cause of PRIS, hypothesized to be either by direct mitochondrial chain inhibition or dysfunctional fatty acid metabolism, remains unclear.3 Since the infancy of the syndrome, cardiac conduction abnormalities and refractory bradycardia hhave been its hallmarks. Case reports have in fact linked PRIS to the sodium channelopathy Brugada Syndrome (BS) known to cause malignant dysrhythmias and sudden death.2,4 ST elevation in a sharp down-sloping so called Brugada like pattern may be a strong initial sign of PRIS.3 Many different presentations of PRIS have been described in the literature but the most consistent known finding is the use of high dose propofol infusion for long duration.5 This risk factor often occurs in critically ill patients requiring propofol therapy for increased intracranial pressure.2,5 Other known findings include metabolic acidosis, lactemia, Acute Renal Failure (ARF), hyperkalemia, elevated triglycerides (TAG), and rhabdomyolysis.5 Early detection and cessation of propofol is the only known method to improve outcome in PRIS.6 Therefore, discovering methods for early detection is imperative.
Wyler, MD, David
"Phenotype Variant Brugada Pattern: An Early Sign of Propofol Infusion Syndrome,"
JHN Journal: Vol. 12
, Article 1.
Available at: http://jdc.jefferson.edu/jhnj/vol12/iss1/1