Have you ever seen someone you know suddenly lose consciousness? Or have you heard of a healthy person dying in their sleep? The cause of such things may be a hidden heart condition that many people have not even heard of. Today we are talking about one such serious and important disease to recognize, Brugada Syndrome.
What is Brugada Syndrome?
Simply put, this is a problem with the electrical system of our heart. Our heart beats like an electrical signal system. In this disease, there is an irregularity in the electrical signals going to the lower chambers of the heart (ventricles).
This causes the heart to beat dangerously fast, almost like it's quivering. This is called `Ventricular fibrillation (v-fib)` in medical terms. When this happens, the heart is unable to pump blood properly to the body. Especially when blood flow to the brain is disrupted, fainting can occur.
The most dangerous thing about this condition is that it can cause sudden cardiac death. This often happens when the patient is at rest, especially during sleep. Research has found that Brugada syndrome is the cause of about 4% of sudden cardiac deaths worldwide.
But this is a very rare condition. On average, between 3 and 5 out of 10,000 people have this disease.
What are the symptoms of this disease?
Although symptoms of Brugada syndrome can appear at any age, they are most common around the age of 40. Surprisingly, more than 70% of people with this condition do not show any symptoms . Someone who does develop symptoms may experience the following:
| Symptom | A simple explanation |
|---|---|
| Fainting/Syncope | Irregular heart rhythms can cause blood supply to the brain to be disrupted, resulting in sudden loss of consciousness and collapse. |
| Dizziness | Feeling dizzy. |
| Heart palpitations | Feeling of a pounding heart, a feeling as if the heart is spinning inside the chest. |
| Difficulty breathing | Difficulty breathing, especially at night. |
| Cardiac Arrest | This may be the first symptom . This is why some people die in their sleep. |
What is escalating this situation?
It is important to be aware of certain things that can trigger or worsen symptoms in someone with Brugada syndrome.
- Fever: Fever is one of the main enemies of this disease. If you have Brugada syndrome, it is essential to take a medicine like paracetamol as soon as you develop a fever, as directed by your doctor.
- Dehydration: When there is not enough water in the body.
- Binge drinking: Consuming a large amount of alcohol at once.
- Certain medications: Medications such as `Sodium channel blockers` used for certain heart conditions, and medications for mental illnesses such as `Lithium` and `Tricyclic antidepressants`.
- Drugs: Drugs such as cocaine and marijuana.
If a doctor confirms that you have this condition, be sure to ask your doctor for a list of medications that you should not take. When taking medication for any other condition, inform the doctor that you have Brugada syndrome.
Why does this disease occur?
In most cases, about 70% of cases, no specific cause can be found for this disease. However, for some people, it is genetic. Simply put, it is hereditary.
- Genetic causes: Changes in more than 18 genes in our body can cause this. Among these, the most common is a mutation in the gene `SCN5A`. Changes in these genes cause disruptions in the transmission of electrical signals in the heart.
- Heredity: If one parent has the gene mutation associated with this disease, there is a 50% chance that a child will inherit it.
Who is most at risk?
- For men: This disease is about 8-10 times more common in men than in women.
- Family history: If someone in your family has Brugada syndrome, or if someone died suddenly at a young age, you may also be at risk.
- Asian origin: This disease has been found to be slightly more common among people in Asian countries than in Western countries.
How to accurately diagnose the disease?
After listening to your symptoms and family history, your doctor will order several tests to confirm whether you have this disease.
| Test | What do you do with it? |
|---|---|
| Electrocardiogram (EKG) | A test that shows the electrical activity of the heart in a line graph. Doctors look for a specific pattern in this pattern that is associated with this disease. Sometimes this pattern is not always visible, so the EKG may need to be done several times. |
| EKG test with drugs (Drug Challenge Test) | If a normal EKG shows a suspicious pattern, a special drug is injected into a vein to try to reveal the hidden Brugada pattern. This is done in a safe place, such as a hospital intensive care unit. |
| Genetic Testing | A sample of your saliva or blood can be used to determine whether you have a genetic mutation associated with this disease. If someone in your family has the disease, others can also get this test. |
| Electrophysiology (EP Test) | This test is done if the diagnosis is still unclear after other tests. This involves inserting a very fine cannula (catheter) through a vein in the leg into the heart and measuring the electrical activity inside the heart. |
How is it treated?
Brugada syndrome cannot be cured completely. However, treatment can be given to prevent sudden cardiac death. The main goal of treatment is to stop dangerous heart rhythm irregularities (ventricular arrhythmias) from occurring and to control them if they occur.
The main and most effective treatment is the implantation of an ICD device .
- ICD (Implantable Cardioverter Defibrillator): This is a small device. It is like a pacemaker. It is implanted under the skin, near the heart, in the chest with a small surgery. It continuously monitors the heart's rhythm. If the heart's rhythm changes dangerously, this device detects it and delivers a small electrical shock to restore the rhythm. This is a life-saving device.
- Medications: Some medications, such as `Quinidine`, can control irregular heart rhythms. However, these are not suitable for everyone.
- Ablation: In some special cases, a treatment method that finds the location of the irregular electrical signals in the heart and destroys them with radio waves.
Doctors decide whether to treat asymptomatic patients based on EKG records, family history, and other test results. Because sometimes the first symptom is sudden death , it is important to assess the risk and treat accordingly.
When should you go to the Emergency Treatment Unit (ETU)?
If you have a sudden cardiac arrest (cardiac arrest), you will need immediate medical attention. Since you will not be able to call for help at that time, it is very important that your family and loved ones are informed about this.
If you are at risk of cardiac arrest, tell your family and close friends to learn how to perform CPR (cardiopulmonary resuscitation). In case of emergency, call 1990 and call an ambulance. This awareness could save your life.
Take-Home Message
- Brugada syndrome is a serious condition that occurs in the heart's electrical system and can even lead to sudden death.
- Fever is a major factor that aggravates this disease. If you develop a fever, reduce it quickly.
- If someone in your family has died suddenly at a young age or you frequently lose consciousness, see a doctor immediately and get an EKG test.
- Implanting an ICD device is the best treatment to save lives from this disease.
- If you have this disease, always be aware of the list of medications that your doctor gives you that are not suitable for you to use.
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