Preprint Case Report Version 1 Preserved in Portico This version is not peer-reviewed

Pectus Carinatum, Small Pneumothorax, and Brugada Patterns: First Description and Pathophysiological Analysis

Version 1 : Received: 9 April 2024 / Approved: 10 April 2024 / Online: 11 April 2024 (13:57:47 CEST)

A peer-reviewed article of this Preprint also exists.

Bermejo Valdés, A. J., Gutiérrez, S. I., & Ruiz, B. T. (2024). First description of a mixed Brugada pattern in inferior leads. Journal of Clinical Cardiology and Cardiovascular Interventions, 7(4). doi: 10.31579/2641-0419/369. Bermejo Valdés, A. J., Gutiérrez, S. I., & Ruiz, B. T. (2024). First description of a mixed Brugada pattern in inferior leads. Journal of Clinical Cardiology and Cardiovascular Interventions, 7(4). doi: 10.31579/2641-0419/369.

Abstract

We present a case report of a young patient with pectus carinatum who experienced a small right apex pneumothorax and exhibited Brugada patterns on electrocardiogram tracing. This is the first clinical case reporting Brugada pattern presentation in both a patient with pectus carinatum and a small pneumothorax. We conducted a clinical, anatomical, and electrocardiographic analysis to explore a physiopathological explanation for these findings, considering our patient had no history or clinical signs of Brugada Syndrome. We conclude that: 1. Pectus carinatum may create a window that facilitates the less resistive measurement of cardiac action potentials; 2. Small pneumothoraces can induce modifications in the cardiac electrical signal detected by surface electrodes, and pectus carinatum could unmask these modifications; and 3. Surface electrodes may measure subepicardial potentials that include and are modified by adjacent pericardial tissues, potentially resulting in alterations in transmural potential differences, thus producing fictitious Brugada patterns. Similarly, there is a possibility that the right ventricular outflow tract may be included within the subendocardial potentials.

Keywords

Brugada Syndrome; Brugada phenocopies; Brugada patterns; pectus carinatum; pneumothorax; subepicardium

Subject

Medicine and Pharmacology, Cardiac and Cardiovascular Systems

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