questions 1

Wolff-Parkinson-White (WPW) Syndrome

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Topic updated on 04/27/17 5:33pm

Snapshot
  • A 25-year-old male presents to the emergency department complaining of palpitations.  He feels anxious, lightheaded, and short of breath.  Current EKG reveals a narrow-complex supraventricular tachycardia.  Looking back at his medical records, you find a baseline EKG from a prior visit when he had arrived at the ED just following resolution of his symptoms.  Baseline EKG is significant for a short PR interval and a wide QRS complex with an initial slurring, or delta wave.  
Introduction
  • Introduction
    • aka ventricular preexcitation syndrome, a form of atrioventricular reciprocating tachycardia (AVRT)
    • congenital syndrome with additional conduction bundle between atrium and ventricle
      • can bypass AV node
      • one type is called the Bundle of Kent
    • part of the ventricular muscle is excited prior to the regular conduction pathway because it is not slowed in the AV node
Presentation and Evaluation
  • Symptoms
    • often asymptomatic though may lead to aberrant reentry current
      • may progress to supraventricular tachycardia resulting in palpitations, anxiety, lightheadedness, chest pain, dyspnea
      • syncope is uncommon
  • Physical exam
    • may see prominent jugular venous puslations (cannon a-waves) during SVT due to atrial contraction against the closed tricuspid valve
    • characteristic delta wave on EKG  
      • due to slurred upstroke of Q-wave as result of partial depolarization prior to normal conduction depolarization
Treatment
  • Management of SVT in WPW
    • drugs that delay AV node conduction (beta-blockers, CCB's, and adenosine) contraindicated
      • increase conduction through accessory pathway and exacerbate condition
    • procainamide or amiodarone used for atrial fibrillation with rapid ventricular response
    • synchronized cardioversion for severely symptomatic
  • Radiofrequency catheter ablation
    • ablation of accessory AV pathways in WPW eliminates arrhythmias in up to 90% of patients


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Qbank (1 Questions)

TAG
(M1.CV.39) An 18-year-old male reports to his physician that he is having repeated episodes of a "racing heart beat". He believes these episodes are occurring completely at random. He is experiencing approximately 2 episodes each week, each lasting for only a few minutes. During the episodes he feels palpitations and shortness of breath, then nervous and uncomfortable, but these feelings resolve in a matter of minutes. He is otherwise well. Vital signs are as follows: T 98.8F, HR 60 bpm, BP 110/80 mmHg, RR 12. Included is a copy of his resting EKG. What is the likely diagnosis? Topic Review Topic
FIGURES: A          

1. Paroxysmal atrial fibrillation
2. Panic attacks
3. Ventricular tachycardia
4. Atrioventricular reentrant tachycardia
5. Atrioventricular block, Mobitz Type II

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