Given the concern for a new diagnosis of WPW, pediatric cardiology was consulted and confirmed the new diagnosis of WPW. Upon a more thorough review of the patient's medical records, an ECG obtained after the termination of her initial episode of SVT from two months after prior was retrieved which did not show evidence of WPW, supporting the diagnosis of intermittent preexcitation (Figure (Figure3). Laboratory values and chest radiograph were unremarkable. The patient reported resolution of symptoms, and repeat vital signs were normal. However, this ECG revealed WPW morphology including short PR interval (100 milliseconds), delta wave, and mildly prolonged QRS (117 milliseconds). After unsuccessful vagal maneuvers, 6 mg of IV adenosine was rapidly administered, followed by rapid administration of 10 milliliters of 0.9% normal saline, demonstrating successful conversion to sinus rhythm on repeat ECG (Figure (Figure2). An ECG confirmed SVT (Figure (Figure1). While the patient appeared uncomfortable, she was speaking in full sentences and reported that symptoms were consistent with her previous episode of SVT. Initial vital signs included heart rate of 200 beats per minute, blood pressure of 97/63 mm Hg, 18 breaths per minute (bpm) and oxygen saturation of 95% on room air. Ī 17-year-old female with past medical history of generalized anxiety disorder (GAD) and one episode of SVT two months earlier presented to the emergency department with a chief complaint of palpitations at rest. ![]() While atrioventricular reentrant tachycardia (AVRT) may comprise the majority of tachyarrhythmias in WPW, atrial fibrillation (AF) and atrial flutter occur in approximately 20% and 7% of WPW patients, respectively. In the pediatric population of 6 to 20 years old, the prevalence of WPW syndrome was less than 0.07%. One cohort study revealed a rate of tachyarrhythmias as 1.0% per year of individuals with WPW pattern. This ECG pattern has been estimated at one to three individuals per 1,000 persons however, the pattern alone is far more common in asymptomatic individuals than those with associated cardiac arrhythmias secondary to the accessory pathway, marking the diagnosis of true WPW syndrome. Classic ECG findings of WPW include a shortened PR interval of less than 120 milliseconds, a slurred upstroke of the QRS complex referred to as the delta wave, and a widened QRS greater than 110 milliseconds. ![]() With a predilection for males most commonly presenting in the third decade of life, this preexcitation syndrome may lead to potentially lethal arrhythmias due to unregulated electrical impulse conduction between the cardiac atria and ventricles. Wolff-Parkinson-White (WPW) syndrome is a form of electrical preexcitation caused by a congenital accessory pathway known as the “Bundle of Kent”, which bypasses normal atrioventricular (AV) nodal and His Purkinje conduction system regulation. The emergency physician should promptly obtain an ECG after the termination of any tachyarrhythmia, and maintain a high index of suspicion for intermittent preexcitation with typical WPW ECG findings which were not present on prior studies. The authors present a case of a 17-year-old female diagnosed with an intermittent preexcitation variant of WPW syndrome after a case of successfully treated symptomatic supraventricular tachycardia (SVT). Consequently, this may adversely affect or delay the appropriate treatment of short-term tachyarrhythmias and long-term definitive therapies for this syndrome. ![]() However, in intermittent preexcitation, a rare variant in contrast to continuous preexcitation, these findings are not always present, thus masking a diagnosis of WPW syndrome. Classic electrocardiogram (ECG) findings of WPW include short PR interval, slurred upstroke of the QRS complex, and prolonged QRS duration. Wolff-Parkinson-White (WPW) syndrome is an uncommon form of cardiac preexcitation due to an underlying structural accessory pathway, which may lead to potentially lethal arrhythmias.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |