Brugada syndrome with elevated cardiac biomarkers

A 45-year-old man presented to our hospital with a history of palpitations, presyncope and chest pain. Vital signs and physical examination were unremarkable. Initial ECG revealed sinus rhythm with non-specific ST changes. Subsequent ECGs showed rsr0 in V1 and saddle-back pattern of ST elevation in lead V2, indicative of type 2 Brugada ECG pattern. Telemetry monitoring revealed multiple runs of asymptomatic non-sustained polymorphic ventricular tachycardia. Ajmaline challenge test confirmed the diagnosis of Brugada syndrome. The subsequent rise and fall of cardiac biomarkers was suggestive of acute myocardial infarction which was refuted by having normal coronaries by cardiac catheterisation. Echocardiogram showed normal cardiac structures and function without any evidence of myopericarditis. Automated intracardiac defibrillator was recommended which the patient declined.