Wolff-Parkinson-White (WPW) Syndrome

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Questions and Answers

In Wolff-Parkinson-White syndrome, what is the primary mechanism by which the accessory pathway leads to ventricular pre-excitation?

  • Slowing conduction through the AV node
  • Enhancing conduction through the Purkinje fibers
  • Blocking conduction through the bundle branches
  • Bypassing the AV node, causing premature ventricular stimulation (correct)

The accessory pathway in Wolff-Parkinson-White syndrome always conducts in both anterograde and retrograde directions.

False (B)

What is the term used to describe the accessory pathway in Wolff-Parkinson-White syndrome?

Bundle of Kent

Wolff-Parkinson-White syndrome is associated with congenital heart diseases such as __________.

<p>Ebstein’s anomaly</p> Signup and view all the answers

Match the ECG finding in WPW with the accessory pathway location:

<p>Type A WPW = Positive delta wave in precordial leads (V1-V6) Type B WPW = Negative delta wave in leads V1 and V2</p> Signup and view all the answers

A 35-year-old male presents with palpitations, dizziness and an ECG showing a short PR interval and delta waves. Which of the following is the MOST likely underlying condition?

<p>Wolff-Parkinson-White Syndrome (C)</p> Signup and view all the answers

Asymptomatic patients with Wolff-Parkinson-White syndrome do not require any follow-up or management.

<p>False (B)</p> Signup and view all the answers

What is the first-line management strategy for a symptomatic episode of Wolff-Parkinson-White syndrome?

<p>Vagal maneuvers</p> Signup and view all the answers

If vagal maneuvers are unsuccessful in terminating a symptomatic episode of Wolff-Parkinson-White syndrome, the next step is usually the administration of intravenous __________.

<p>adenosine</p> Signup and view all the answers

Which of the following ECG findings is NOT typically associated with Wolff-Parkinson-White syndrome?

<p>ST segment elevation (B)</p> Signup and view all the answers

Catheter ablation of the accessory pathway is an ineffective long-term management strategy for Wolff-Parkinson-White syndrome.

<p>False (B)</p> Signup and view all the answers

What genetic mutation is associated with some cases of Wolff-Parkinson-White syndrome?

<p>PRKAG2 gene</p> Signup and view all the answers

The risk of sudden cardiac death in asymptomatic patients with Wolff-Parkinson-White Syndrome is approximately __________ per year.

<p>0.1%</p> Signup and view all the answers

Which of the following is NOT a typical symptom associated with Wolff-Parkinson-White syndrome?

<p>Bradycardia (B)</p> Signup and view all the answers

Patients with Wolff-Parkinson-White syndrome are typically asymptomatic and do not experience any noticeable symptoms.

<p>False (B)</p> Signup and view all the answers

A patient with known WPW presents to the ER complaining of palpitations, chest pain and shortness of breath. Vitals reveal a HR if 220 bpm. Vagal maneuvers are unsuccessful, what intervention is MOST appropriate?

<p>Administer intravenous adenosine (C)</p> Signup and view all the answers

An exercise __________ test may help establish the relationship between exercise and tachyarrhythmias associated with Wolff-Parkinson-White syndrome.

<p>stress</p> Signup and view all the answers

What is the approximate prevalence of Wolff-Parkinson-White syndrome in the general population?

<p>1-3 per 1000</p> Signup and view all the answers

Alcohol consumption is not known to trigger episodes of tachyarrhythmia in individuals with Wolff-Parkinson-White syndrome.

<p>False (B)</p> Signup and view all the answers

Which of the following is NOT a differential diagnosis that should be considered when evaluating a patient for potential Wolff-Parkinson-White syndrome?

<p>Mitral valve stenosis (A)</p> Signup and view all the answers

A 60-year-old patient with a history of WPW presents with recurrent episodes of SVT. Catheter ablation is not an option due to other health conditions. Which medication is MOST likely to be prescribed for long term management?

<p>Amiodarone (D)</p> Signup and view all the answers

Unlike normal conduction pathways in the heart, conduction through the accessory pathway in WPW is not regulated by the __________.

<p>AV node</p> Signup and view all the answers

ST segment and T wave changes on an ECG are unrelated to Wolff-Parkinson-White syndrome.

<p>False (B)</p> Signup and view all the answers

Elevated __________ and __________ levels may suggest heart failure as a result of prolonged tachyarrhythmia.

<p>BNP, NT-proBNP</p> Signup and view all the answers

Match symptom with potential intervention for WPW.

<p>Tachyarrhythmia = Adenosine Palpitations = Valsalva Maneuver Long-Term SVT prevention = Amiodarone</p> Signup and view all the answers

Flashcards

Wolff-Parkinson-White (WPW) syndrome

A syndrome predisposing to supraventricular tachycardia due to an accessory pathway in the heart.

WPW Aetiology

The accessory pathway bypasses the AV node, causing premature ventricular excitation.

WPW Risk Factors

Males aged 30-40 years. Can be sporadic or inherited (PRKAG2 gene). Associated with Ebstein’s anomaly.

WPW Clinical Features

Palpitations, lightheadedness, presyncope, syncope, cardiac arrest. Chest pain, shortness of breath, sweating may also occur.

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WPW Differential Diagnoses

Atrial fibrillation, atrial flutter, AVNRT, ventricular fibrillation, ventricular tachycardia, valvular disease, Ebstein’s anomaly and hypertrophic cardiomyopathy.

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WPW ECG Findings

Short PR interval (<0.12s), delta wave, broad QRS complex. ST segment and T wave changes.

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Type A WPW

Left-sided accessory pathway with positive delta wave in precordial leads (V1-V6).

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Type B WPW

Right-sided accessory pathway with negative delta wave in leads V1 and V2.

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WPW Laboratory Investigations

FBC, U&E, LFT, thyroid function tests to rule out other causes.

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WPW Imaging

Chest X-ray to rule out other causes. Echocardiogram to rule out structural heart disease.

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WPW Other Investigations

Ambulatory ECG monitoring, exercise stress test, electrophysiology studies.

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Asymptomatic WPW Management

Regular follow-up and lifestyle changes to reduce tachyarrhythmia episodes.

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Symptomatic WPW Episode Management

Vagal manoeuvres (Valsalva manoeuvre), intravenous adenosine, cardioversion if adenosine fails.

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WPW Long-Term Management

Catheter ablation of the accessory pathway, daily amiodarone to prevent tachyarrhythmias.

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WPW Complications

Palpitations, dizziness, syncope, sudden cardiac death.

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Study Notes

  • Wolff-Parkinson-White (WPW) Syndrome predisposes individuals to supraventricular tachycardia due to an accessory pathway in the heart.
  • WPW presents with characteristic ECG findings, tachyarrhythmias, and clinical symptoms of tachycardia.

Aetiology

  • An accessory pathway leads to ventricle stimulation, bypassing the AV node and causing premature excitation.
  • Double excitation of the ventricles occurs due to the accessory pathway.
  • The accessory pathway, also called the 'bundle of Kent', can be left or right-sided.
  • Accessory pathway may conduct both anterograde and retrograde.

Risk factors

  • WPW is most common in males aged 30-40 years old.
  • Most cases are sporadic, some result from an inherited mutation in the PRKAG2 gene (autosomal dominant).
  • WPW is associated with congenital heart disease like Ebstein’s anomaly.

Clinical features

  • Clinical features are caused by tachyarrhythmias.
  • Typical symptoms include palpitations, lightheadedness, presyncope, syncope, and cardiac arrest.
  • Other symptoms can include chest pain, shortness of breath, and sweating.
  • Symptoms vary from seconds to hours and can be triggered by exercise, alcohol, or caffeine.

Differential diagnoses

  • Main differentials include other tachyarrhythmias like atrial fibrillation, atrial flutter, AVNRT, ventricular fibrillation, and ventricular tachycardia.
  • Other conditions include valvular disease, Ebstein’s anomaly, and hypertrophic cardiomyopathy.

Investigations

  • An ECG is a key investigation
  • Key ECG features of WPW:
    • Short PR interval ( 110ms)
    • ST segment and T wave changes
    • Prominent R waves in V1-3
  • Type A (left-sided) WPW has a positive delta wave in precordial leads (V1 – V6).
  • Type B (right-sided) WPW has a negative delta wave in leads V1 and V2.
  • Relevant laboratory investigations include:
    • Full blood count
    • Urea and electrolytes
    • Liver function tests
    • Thyroid function tests
  • Imaging investigations:
    • Chest X-ray (rule out other causes)
    • Echocardiogram (rule out structural heart disease and assess left ventricular function)
  • Other investigations:
    • Ambulatory ECG monitoring
    • Exercise stress test
    • Electrophysiology studies

Management

  • Asymptomatic patients need regular follow-up and lifestyle changes to reduce episodes.
  • During symptomatic episodes:
    • Vagal manoeuvres (Valsalva manoeuvre)
    • Intravenous adenosine if vagal manoeuvres fail
    • Cardioversion if adenosine fails
  • Long-term options:
    • Catheter ablation of the accessory pathway
    • Daily amiodarone to prevent tachyarrhythmias

Complications

  • Complications include palpitations, dizziness, syncope, and sudden cardiac death.
  • The risk of sudden cardiac death is approximately 0.1% in asymptomatic and 0.3% in symptomatic patients per year.

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