tag:blogger.com,1999:blog-549949223388475481.post9159772001276437729..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: A young F is hyperthermic, delirious, and dry: Fever-induced Brugada? Diphenhydramine toxicity? Tricyclic?Unknownnoreply@blogger.comBlogger5125tag:blogger.com,1999:blog-549949223388475481.post-17946158174813524242019-12-08T12:16:12.493-06:002019-12-08T12:16:12.493-06:00Gracias otra vez, Hector. Although when I was Atte...Gracias otra vez, Hector. Although when I was Attending, the thought of a Brugada Syndrome-induced arrhythmia in a pediatric patient who presented with a clear febrile seizure was not something that passed my mind — But, your question, and this case study makes one reconsider … — https://pediatrics.aappublications.org/content/119/5/e1206?download=true — I would think routine ECGs in the very young with what appears to be a clear febrile seizure are not generally indicated — but — IF there is a positive family history of sudden death in a close blood relative to such a child (as you suggest) — then Brugada Syndrome merits consideration. THANKS again for your comment, Hector. Input from others (Any pediatric cardiologists out there?) on this question is welcomed! — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-63525831381286978002019-12-08T07:25:48.125-06:002019-12-08T07:25:48.125-06:00I do agree with Dr Grauer, an EP cardiology evalua...I do agree with Dr Grauer, an EP cardiology evaluation seems to be warranted. On the other hand, what worries me more is the frequently diagnosed "Febrile benign convulsion" in kids that present to the E.D (at least in our country) with fever and an apparent convulsion. We are trying to educate our Pediatric specialists on this topic and obtain a detailed family Hx in every case and keep in mind all those red flags. <br />Thanks again to Dr Smith and Dr Grauer<br />H Munoz, MD Caracas VenezuelaHector Munozhttps://www.blogger.com/profile/10157498764409620840noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-29419184896751325132019-12-07T12:52:19.461-06:002019-12-07T12:52:19.461-06:00Brugada ECG is spontaneous. Fever does not qualif...Brugada ECG is spontaneous. Fever does not qualify as provoked (an EP study with Na channel blockade would) + sudden death in mother. This is my understanding. And this is the score that the EP doc gave too.Anonymoushttps://www.blogger.com/profile/10503537232697503615noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-51028702020407512402019-12-07T12:25:22.329-06:002019-12-07T12:25:22.329-06:00Thanks for your question Andy! I have not used the...Thanks for your question Andy! I have not used the risk score that you refer to — so I will refer your question to Dr. Smith for his input on this. That said, the “P.S.” ( = very last paragraph) in My Comment above reflects my concern, namely SUDDEN DEATH in the mother during sleep (ie, presumably cause unknown, but potentially arrhythmic in nature) — in addition to the decidedly positive Brugada-1 ECG pattern that this previously healthy 30-something y.o. woman developed (even though induced by fever) — would seem more than ENOUGH to justify full evaluation by EP Cardiology, regardless of any numerical risk score her case may have generated. Dr. Smith cites lots of literature (above) indicating increased risk posed by febrile induction of Brugada-1 ECG patterns.ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-71850112026813173692019-12-05T22:58:56.271-06:002019-12-05T22:58:56.271-06:00Great case once again! Question is, why 2 points o...Great case once again! Question is, why 2 points on the risk score. This is not spontaneous but rather “provoked” Type 1 so 1 point for FHx? No?AndyWhttps://www.blogger.com/profile/06024384583116150941noreply@blogger.com