{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:06:27Z","timestamp":1790136387508,"version":"4.0.1"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2020,12,2]],"date-time":"2020-12-02T00:00:00Z","timestamp":1606867200000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Discovering concomitant diagnoses results in a challenge to determine the true cause of a patient\u2019s presentation. Evaluating this fully is vital to plan appropriate and avoid inappropriate therapy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A 55-year-old gentleman presents in cardiac arrest whilst watching an unusual occurrence of England dominating a Football World Cup game vs. Panama in 2018. Diagnostic coronary angiography discovered an anomalous right coronary artery from the opposite sinus (R-ACAOS), but clinical suspicion this was incidental lead to a further diagnosis of Type 1 Brugada Syndrome (BrS) following a positive Ajmaline provocation challenge. Risk stratification of these two zebras using computed tomography coronary angiography (CTCA), Cardiac magnetic resonance imaging (CMRI), Exercise Stress Echocardiography was performed and following a multi-disciplinary meeting, BrS was felt to be the primary diagnosis. The patient received a secondary prevention implantation of a cardiac defibrillator and avoided cardiac surgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Diagnosing a rare condition does not necessarily mean it is the cause of a patient\u2019s presentation and should not end the investigative process. Right coronary artery from the opposite sinus rarely causes cardiac arrest in middle age and is typically associated with peak exercise. Type 1 BrS is associated with cardiac arrest with vagal activity, perhaps such as England winning a World Cup game! Clinical correlation and risk stratification is required for suspected incidental findings.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaa425","type":"journal-article","created":{"date-parts":[[2020,12,2]],"date-time":"2020-12-02T06:57:49Z","timestamp":1606892269000},"page":"1-6","source":"Crossref","is-referenced-by-count":2,"title":["Two zebras and a cardiac arrest: a case report of concomitant Brugada syndrome and an anomalous coronary artery"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5517-1964","authenticated-orcid":false,"given":"Alexander","family":"Bates","sequence":"first","affiliation":[{"name":"Department of Cardiology, E Level, North Wing, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9317-7363","authenticated-orcid":false,"given":"Waqas","family":"Ullah","sequence":"additional","affiliation":[{"name":"Department of Cardiology, E Level, North Wing, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Wilkinson","sequence":"additional","affiliation":[{"name":"Department of Cardiology, E Level, North Wing, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3084-5106","authenticated-orcid":false,"given":"James","family":"Shambrook","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Radiology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,12,2]]},"reference":[{"key":"2021010812224422600_ytaa425-B1","first-page":"267","article-title":"Worldwide prevalence of Brugada syndrome: a systematic review and meta-analysis","volume":"34","author":"Vutthikraivit","year":"2018","journal-title":"Acta Cardiol Sin"},{"key":"2021010812224422600_ytaa425-B2","first-page":"205","article-title":"A systematic overview of anomalous coronary anatomy and an examination of the association with sudden cardiac death","volume":"7","author":"Lorenz","year":"2006","journal-title":"Rev Cardiovasc Med"},{"key":"2021010812224422600_ytaa425-B3","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1016\/j.hrthm.2013.07.030","article-title":"Fever-induced Brugada pattern: how common is it and what does it mean?","volume":"10","author":"Adler","year":"2013","journal-title":"Hear Rhythm"},{"key":"2021010812224422600_ytaa425-B4","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1161\/CIRCEP.109.862441","article-title":"Exercise-induced ECG changes in Brugada syndrome","volume":"2","author":"Amin","year":"2009","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2021010812224422600_ytaa425-B5","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1016\/j.hrthm.2009.07.002","article-title":"Drugs and Brugada syndrome patients: review of the literature, recommendations, and an up-to-date website (http:\/\/www.brugadadrugs.org)","volume":"6","author":"Postema","year":"2009","journal-title":"Heart Rhythm"},{"key":"2021010812224422600_ytaa425-B6","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1046\/j.1540-8167.2003.02389.x","article-title":"Effects of glucose-induced insulin secretion on ST segment elevation in the Brugada syndrome","volume":"14","author":"Nishizaki","year":"2003","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2021010812224422600_ytaa425-B7","first-page":"797","article-title":"Images in cardiology. 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