An Autopsy Case of Brugada Syndrome with Prominent J Wave in the Inferior Leads Presenting Headache and Chest Pain

• Published in: Japanese Journal of Electrocardiology Vol. 37; no. 1; pp. 23 - 30
• Main Authors: Ohtani, Ryuji, Yamashita, Michiko, Chen, Hirotoshi, Tobetto, Yohei, Yoneda, Kohei, Izumi, Tomoko, Miyajima, Hitoshi, Yasuoka, Tatsuo, Ogura, Riyo, Yuba, Kenichiro, Takahashi, Takefumi, Hosokawa, Shinobu, Kishi, Koichi, Hiasa, Yoshikazu, Fujii, Yoshiyuki
• Format: Journal Article
• Language: Japanese
• Published: Japanese Heart Rhythm Society 2017
• Subjects: Autopsy; Brugada syndrome; Cardiac standstill; J wave
• ISSN: 0285-1660; 1884-2437
• DOI: 10.5105/jse.37.23

We report the case of a 27-year-old male who had visited our hospital complaining of headache and chest pain during sleep. He had neither a family history of sudden cardiac death nor a past history of syncope and arrhythmias. Twelve-lead ECG showed coved-type ST-segment elevation in the right precordial leads and prominent J wave in the inferior leads. Laboratory tests and echocardiography were normal. He made an emergency visit one month later, presenting cardiac standstill. He died without response to cardiopulmonary resuscitation. Autopsy revealed no gross abnormality. A more detailed pathological evaluation led to some characteristic findings. Bilateral ventricular wall showed irregular thickness with mild myocardial hypertrophy. An epicardial fibrofatty degeneration and myocardial bundle around the vasculature were observed in the left anterior and posterior wall, right wall of the apex, and right ventricular outflow tract. In addition, focal inflammation with multinuclear leukocytes was seen in the epicardium by the right ventricular outflow tract. These findings are consistent with previous autopsy reports for patients with Brugada syndrome.