COVID-19-induced Brugada phenocopy pattern in a patient with previous myocardial infarction: A case report

Rationale: Coronavirus disease 2019 (COVID-19) can cause electrocardiographic changes, such as ST-segment elevation, by increasing the dispersion of cardiac repolarization or cause delayed depolarization in a localized area of the right ventricular outflow, leading to clinical misdiagnosis. Patient concerns: A 57-year-old man with a history of hypertension and previous myocardial infarction presented to the emergency department with a 12-hour history of fever, chest tightness, and palpitations. Diagnoses: An emergency electrocardiogram (ECG) showed sinus rhythm with abnormal Q waves and ST-segment elevation (0.1–0.35 mV) in leads V1–V3. A positive COVID-19 polymerase chain reaction test and specific ECG metrics, including β-angle measurement and r’-wave triangle base duration, led to the diagnosis of a Brugada phenocopy pattern triggered by COVID-19. Interventions: The patient was treated with an antiplatelet agent (clopidogrel), an antipyretic (acetaminophen) for fever, and oral antivirals (nimatrelvir/ritonavir). Outcomes: After 2 days, his temperature normalized, and a repeat ECG showed resolution of ST-segment elevation. Lessons: This case highlights the importance of considering fever-induced Brugada phenocopy in the differential diagnosis of ST-segment elevation in patients with coronary artery disease. Careful ECG analysis, including assessment of the β-angle and r’-wave morphology, is crucial to avoid misdiagnosis of ST-elevation myocardial infarction. Initial management should focus on controlling triggering factors such as fever with antipyretics and antivirals to prevent malignant arrhythmias.