Cardiac ECG

Question 1

Associations of WPW

Answer 1

HOCM
mitral valve prolapse
Ebstein's anomaly
thyrotoxicosis
secundum ASD

Question 2

Mx of WPW

Answer 2

Definitive treatment: radiofrequency ablation of the accessory pathway
medical therapy: sotalol***, amiodarone, flecainide

• in the majority of cases, or in a question without qualification, Wolff-Parkinson-White syndrome is associated with left axis deviation
• *there is a rare type C WPW, WPW in which the delta waves are upright in leads V1-V4 but negative in leads V5-V6
• **sotalol should be avoided if there is coexistent atrial fibrillation as prolonging the refractory period at the AV node may increase the rate of transmission through the accessory pathway, increasing the ventricular rate and potentially deteriorating into ventricular fibrillation

Question 3

CHA2DS2VaS Score?

Answer 3

Risk factor	Points
C	Congestive heart failure	1
H	Hypertension (or treated hypertension)	1
A2	Age >= 75 years	2
Age 65-74 years	1
D	Diabetes	1
S2	Prior Stroke or TIA	2
V	Vascular disease (including ischaemic heart disease and peripheral arterial disease)	1
S	Sex (female)	1

Question 4

Atrial fibrillation - cardioversion

Answer 4

amiodarone + flecainide

others (less commonly used in UK): quinidine, dofetilide, ibutilide, propafenone