16813 Brugada Syndrome

Overview

Brugada syndrome is a rare heart condition that affects the heart's electrical system. It can increase the risk of a fast, irregular heartbeat that may lead to fainting or sudden cardiac arrest, especially during rest or sleep.

No, Brugada syndrome is rare. It is estimated to affect between 1 in 5,000 and 1 in 10,000 people worldwide.

Brugada syndrome can affect anyone, but it is more common in men and in people of Asian descent. Symptoms can first appear at any age, including childhood, but are most common in adults in their 30s and 40s.

Symptoms

Common symptoms

• Fainting (syncope) that happens suddenly, especially during sleep or at rest.
• A racing or fluttering heartbeat (palpitations).
• Gasping for breath or irregular breathing during sleep.
• No symptoms at all in some people (the condition is found during a heart test for another reason).

Symptoms in children

• Fainting or seizures that may be mistaken for epilepsy.
• Unusual sleepiness or difficulty waking.
• Irregular heartbeats that cause dizziness or fainting.

Symptoms in older adults

• Fainting or blackouts, which can be mistaken for a sign of ageing.
• Shortness of breath or fatigue.
• Some older adults may not have symptoms, but the risk of irregular heartbeats remains.

Causes

Main causes

• A change (mutation) in a gene that controls the heart's electrical signals.
• The condition is usually inherited from a parent, but sometimes it happens without a family history.
• Fever or certain medications can trigger a dangerous rhythm in someone with Brugada syndrome.

Risk factors

• A family history of Brugada syndrome or unexplained sudden death in a young family member.
• Being male.
• Being of Asian or Southeast Asian descent.
• Having other health conditions that affect the heart or electrolytes.

When to see a doctor

See a doctor urgently if:

• If you faint without a clear reason, see a doctor as soon as possible.
• If you have palpitations that are new, frequent, or cause dizziness.
• If a family member has been diagnosed with Brugada syndrome, ask about genetic testing.

Book a routine appointment if:

• If you have a family history of Brugada syndrome, even without symptoms, consider a check-up.
• If you have been feeling dizzy or tired for a while, it is worth discussing with a doctor.

Diagnosis

Brugada syndrome is diagnosed by a heart specialist (cardiologist) using an ECG (electrocardiogram) that records the heart's electrical activity. Sometimes a special ECG with a medicine is used to reveal the pattern.

Tests that may be done

• ECG (electrocardiogram) — a quick, painless test that measures the heart's rhythm.
• Blood tests to check for other causes.
• A genetic blood test to look for the faulty gene.
• A referral to a specialist to confirm the diagnosis.

What to expect at your appointment

The doctor will ask about your symptoms, family history, and do an ECG. If the first ECG is normal, you may be asked to come back for more tests, including a 24-hour heart monitor or an ECG after exercise. To get a clear picture, you may also be referred to a specialist clinic.

Treatment

Treatment for Brugada syndrome focuses on reducing the risk of dangerous heart rhythms. Not everyone with the condition needs the same treatment. The plan depends on your risk, symptoms, and family history.

Self-care at home

• Avoid medicines that are known to trigger Brugada syndrome (ask your doctor or pharmacist before taking any new medicine).
• Treat fever quickly with paracetamol or by cooling the body — fever is a common trigger.
• Tell all your doctors and dentists that you have Brugada syndrome before any procedure.
• Avoid heavy alcohol use and extremely heavy exercise if you are at higher risk, as advised by your doctor.

Medical treatments

A heart specialist may recommend an implantable cardioverter-defibrillator (ICD) — a small device placed under the skin that checks the heart rhythm and delivers a shock if a dangerous rhythm happens. Some people may be prescribed medication to help prevent irregular heartbeats. Your doctor will discuss the best options for you. You should also have regular check-ups with your heart team to monitor your condition.

When is surgery considered?

An ICD is placed in a minor surgical procedure. This is recommended for people who have had a dangerous heart rhythm, fainting due to the condition, or a strong family history of sudden death.

Living with this condition

Many people with Brugada syndrome live full and active lives. You will need regular check-ups with a cardiologist and to be aware of the warning signs to seek help quickly.

Lifestyle tips

• Keep a list of your medications and check with a pharmacist before any new one.
• If you feel feverish, check your temperature and take steps to bring it down.
• Wear a medical alert bracelet or carry a card saying you have Brugada syndrome.
• Learn the heart rhythm that triggers your symptoms and tell your family what to do.

Diet and exercise

There is no special diet for Brugada syndrome, but eating a balanced diet and staying moderately active are good for heart health. Extreme intensive exercise is generally discouraged, but walking, swimming, and cycling are safe. Ask your doctor about your individual limits.

Mental health and emotional wellbeing

Living with a heart rhythm condition can cause anxiety, especially after a collapse or diagnosis. It is normal to worry. Talk to your doctor about how you are feeling and consider counselling or support groups to help you cope.

Prevention

Brugada syndrome itself is genetic and cannot be prevented. However, dangerous episodes may be prevented by avoiding triggers, treating fever early, and having the right treatment plan in place.

Vaccines

There is no special vaccine for Brugada syndrome, but keeping up to date with regular vaccines is important to avoid infections that can cause fever.

Screening programmes

If you have a family member with Brugada syndrome, genetic testing can help identify those at risk. Family members who test positive can then be monitored by a specialist.

Complications

If left untreated

• Individual episodes of fainting can lead to injury.
• A fast, irregular heartbeat can lead to sudden cardiac arrest if not treated with emergency care.
• Untreated Brugada syndrome can cause repeat fainting spells, which may affect work, driving, and daily life.

Long-term outlook

With the right diagnosis and treatment, most people with Brugada syndrome lead long and full lives. The most important step is talking to a specialist, following your plan, and wearing a medical alert device if recommended. There are many effective ways to manage the condition.

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