Hindawi Publishing Corporation Case Reports in Cardiology Volume 2013, Article ID 704859, 3 pages http://dx.doi.org/10.1155/2013/704859 Case Report Brugada Pattern Electrocardiogram Unmasked with Cocaine Ingestion M. Chadi Alraies, 1 Mohammed A. R. Chamsi-Pasha, 2 Motaz Baibars, 3 Abdul Hamid Alraiyes, 4 and Khaldoon Shaheen 1 1 Department of Hospital Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Avenue, Mail Code A13, Cleveland, OH 44195, USA 2 Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44195, USA 3 Department of Hospital Medicine, Peninsula Regional Medical Center, Salisbury, MD 70118, USA 4 Tulane University Health Sciences Center, Pulmonary Diseases, Critical Care and Environmental Medicine, New Orleans, LA, USA Correspondence should be addressed to M. Chadi Alraies; alraies@hotmail.com Received 17 December 2012; Accepted 16 January 2013 Academic Editors: G. Minardi and D. Richter Copyright © 2013 M. Chadi Alraies et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Cocaine is considered a leading cause of drug-related deaths. his is usually sudden, unwitnessed, and without prodromal features. It has been reported that in-hospital mortality is close to 2%. Cocaine has powerful central nervous system efects 1 and acute cocaine overdose has been associated with hyperthermia, agitation, paranoid ideation, status epilepticus, ventricular ibrillation, ventricular tachycardia, and myocardial infarction (MI). he mechanisms of cocaine-related death remain poorly understood. We report a patient who survived massive cocaine ingestion with psychomotor agitation and generalized seizures followed by asystolic cardiac arrest and transient Brugada pattern on electrocardiogram (ECG). 1. Introduction he use of cocaine in the United States is increasing and the incidence of hospitalizations and deaths from cocaine overdose is escalating. he mechanisms of cocaine-related death remain poorly understood. Cocaine has been asso- ciated with diferent types of cardiac dysrhythmias, most commonly: supraventricular tachycardia, complete bundle- branch block, complete heart block, ventricular tachycardia, torsade de pointes, ventricular ibrillation, asystole, and Brugada pattern. We report a patient who survived massive cocaine ingestion with asystolic cardiac arrest and transient Brugada pattern on electrocardiogram (ECG). 2. The Case A previously healthy 27-year-old man ingested a bag of cocaine as an impulsive gesture to avoid police detection. One hour later, he developed psychomotor agitation followed by generalized tonic-clonic seizures. he patient was trans- ported to the emergency department and the seizures sub- sequently terminated with intravenous lorazepam. Later, the patient was noticed to be in ventricular asystole. he patient was resuscitated to a spontaneous rhythm through which epinephrine and sodium bicarbonate were given. Following resuscitation, the patient was intubated and mechanically ventilated. On exam, temperature was 39 ∘ C, pulse 70/min, blood pressure 90/70 mmHg, respiratory rate 32/min, oxygen saturation 98% with full ventilator support (FiO 2 100%), and Glasgow Coma scale of 5/15. Chest examination revealed bibasilar crackles. Heart exam was signiicant for regu- lar rate and rhythm with frequent escaped beats. Blood work was within normal limit except for bicarbonate of 5.4 mEq/L, anion gap of 36, and creatinine of 1.8 mg/dL. Arterial blood gas showed pH of 6.1, PCO 2 of 86 mmHg, HCO 3 of 5.4 mEq/L, and PO 2 of 350 mmHg. Troponin I was 50.90 ng/mL. Urine toxicology screen was positive for cocaine. Electrocardiogram (ECG) (Figure 1(a)) showed