Brugada Sendromuna Bağlı Kardiyak Arrestte Yoğun Bakım Yönetimi
Özet
Brugada Sendromu (BrS); kalbin ileti sistemindeki iyon kanallarını etkileyerek, malign ventriküler aritmiler ve ani kardiyak arreste neden olabilen otozomal dominant bir hastalıktır. Elektrokardiyografide (EKG) elektrolit bozukluğu, kalp hastalığı veya kardiyak iskemi olmaksızın sağ dal bloğu ve V1–3 derivasyonlarda ST elevasyonu paterni ile karakterizedir. Genç yaşta ani kardiyak arrestte neden olan ve kolayca farkına varılamayan bu sendromun tanınamaması hastalarda primer koruma şansını da ortadan kaldırmakta ve prognozunu kötü etkileyebilmektedir. Ayrıca otozomal dominant geçişli bir hastalık olması nedeniyle konuyla ilgili hastanın birinci derece yakınları ayrıntılı şekilde bilgilendirilmeli ve farkındalık oluşturulmalıdır. Önerilen tek etkili tedavi yöntemi şu an için ICD yerleştirilmesidir. Ani kardiyak arrest ile gelen genç yaştaki hastalarda BrS’nin tanı ve tedavisinin planlanması oldukça önemlidir.
Bu olguda ventriküler fibrilasyon sonrası kardiyak arrest nedeniyle yoğun bakım ünitemizde takip ve tedavi edilen Brugada sendromlu bir hastanın yoğun bakım yönetimi literatür eşliğinde ele alınmıştır.
Brugada Syndrome (BrS) is an autosomal dominant disorder that can cause malignant ventricular arrhythmias and sudden cardiac arrest by affecting ion channels in the conduction system of the heart. It is characterized by right bundle branch block and ST elevation pattern in leads V1-3 without electrolyte disturbance/heart disease/cardiac ischemia on electrocardiography (ECG). Failure to recognize this syndrome, which causes sudden cardiac arrest at a young age and can be easily overlooked, eliminates the chance of primary prevention and may have a poor prognosis. In addition, since it is an autosomal dominantly inherited disease, the first-degree relatives of the patient should be informed in detail and awareness should be raised. The only effective treatment method currently recommended is ICD implantation. It is very important to plan the diagnosis and treatment of BrS in patients presenting with sudden cardiac arrest at a young age.
In this case, the intensive care management of a patient with Brugada syndrome who was followed and treated in our intensive care unit due to cardiac arrest after ventricular fibrillation is discussed in the light of the literature.
Referanslar
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