Selective Nonischemic Stsegment Elevation In The Right Precordial Leads

High-takeoff ST segments of either the caved or saddleback type localized to the right chest leads associated with different degrees of right bundle block with or without T-wave inversion and sudden death due to ventricular fibrillation are seen in the Brugada syndrome32 (Fig. 11-5, left). This is a familial entity ascribed to a "primary" electrophysiologic abnormality. Similar findings were reported in the familial cardiomyopathy and sudden cardiac death syndrome described by Corrado et al.33 Strong Na channel blocking drugs can produce ST-segment elevations even in patients without any evidence of syncope or ventricular fibrillation.34 The changes produced by potassium are discussed in the section of hyperkalemia (below). Slight ST-segment elevation with an incomplete right bundle branch block pattern showing an epsilon wave has been described in arrhythmogenic right ventricular dysplasia35 (see Fig. 11-5, right).

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