Pandora’s Box

The definition of opening Pandora’s Box; “to open Pandora’s box” means to perform an action that may seem small or innocent, but that turns out to have severe and far-reaching consequences. Ever feel like this is Brugada Syndrome?? I do. I went to the doctor for palpitations and fluttering. My EKG was abnormal but it always was and no one said anything about it. The EP suggested a genetic test. Seemed scary but he said it was unlikely so in turn it felt small. It felt like a small, minor decision that I was doing to cover my back not thinking what if it DOES come back positive?? I threw the lid off the box, thinking I might get a simple, small answer to my palpitations and all will be solved with a prescription. Well you all know the story. It was positive, my EP feels cardiac arrest is imminent, there is no pill and no cure. Just a pesky little device to start my heart again if it should stop, that may possibly run amuck on accident and kill me instead of Brugada. Some may say this is great news! I just saved my life! I will live long! I won’t end up like my father! Im lucky, the answer to my prayers, a second chance, blah, blah, blah. But what about the consequences of knowing this knowledge? Maybe knowledge isn’t always power. Maybe ignorance is truly bliss? What am I talking about? Is it good quality of life to walk around knowing a shock or cardiac arrest is imminent? Is it a peaceful life knowing the same ICD that may save you has MANY risks to actually having it in the first place?? We all walk around with that fear. You know you do! We all wonder when that moment will arrive….what if we are driving? What if we are with our kids? What if we are walking on stairs? What if we are near something hard and pointy that would cause a catastrophic blow if we fell unconscious on it? With every breathe and every step we wonder and wonder and wonder. What if now? what if later? When will it happen? Once again, is that quality of life? We saved our lives but are burdened with the ‘what ifs’ every day of our life. Sometimes I wish I never went to that appointment or got that test. Thats silly talk right? After all, that appointment diagnosed me and saved my life. But yet, it gave me knowledge that a shock or arrest or VFib or a faint or fall is around the corner ready to pounce on me. People may say “so what? you will be alive!” Will I? What if Im driving and hit a pole? What if I fall and get head trauma? Its happened!! What if it dislodges a lead?? Okay, Ill stop. I don’t want to scare all my readers away lol! But I know you all understand what Im talking about. Your happy you know about Brugada because you’ll live but you wish you didn’t know so you didn’t have to endure fear and anxiety everyday.Its a love hate relationship. Maybe we should have left the lid on that damn box!! Maybe not….

Brugada and Fevers

Most of us know that a fever is used to to help diagnose Brugada. Many people who are symptom free may all of a sudden have symptoms and an abnormal EKG while they have a fever. That is because heat in the form of your core body temp can alter your heart rhythm. Many people found out they had Brugada when they were sick with a fever. When a doctor suspects that you MAY have Brugada they also want you to get an EKG when you have a fever. If there is a change to your EKG with fever it helps them diagnose you and find your risk. But what if you already have Brugada? Should fevers be a concern? ABSOLUTELY!! It may be used as a diagnostic tool but it doesn’t change the fact that even if you already know you have Brugada, a fever can change your rhythm and may cause Vtach or Vfib. That may not always happen but its best to be prepared. If you have Brugada and your getting sick, treat the fever non stop. It may land you in the hospital if you don’t. I had a fever from strep throat and it didn’t make my heart go out of control terribly but it aggravated it enough that I had to call m EP and take Cardizem, a calcium channel blocker, while fevered to keep the palpitations at bay and keep my heart rate down. So always be aware of sickness and ANYTHING that can raise your temp. Even being out on a hot beach, doing yard work,etc can aggravate your heart.

 

I do want to mention an episode my 4 year old had. She is positive genetically for Brugada. She is asymptomatic and all her tests are normal. Brugada generally gets worse with age so this is no surprise that for now everything is normal. Just because your safe in childhood doesn’t mean you will be safe in adulthood. But her EP, although she knows she already had Brugada, still wants an EKG with fever. I was confused thinking that was only a diagnostic tool to see if you have it. But thats not the case. Even if you have it they want to know your risk. She had a fever and off to the hospital we went. She had an EKG that indeed showed minor signs of Brugada!! Otherwise her EKG is normal. This is proof further that Brugada CAN cause symptoms in her and is reason for the EP to watch her even closer. 

So my dear readers, please use a fever to your benefit, whether waiting for a diagnosis, already have it or assessing risk. And either way, no matter what category you are in, treat the fever right away. Once its reduced the symptoms go away. Make sure you always get an EKG with fever UNMEDICATED to see how your heart truly reacts 🙂