Wolff parkinson white

Question 1

Define Wolff-parkinson White syndrome

Answer 1

WPW pattern-see on ECG but no symptoms
WPW syndrome-symptoms and ECG

When more than one fibre (accessory fibres) can conduct. Have a signal pass via normal fibres (aV node), then another down accessory fibres

Question 2

Aetiology and risk factors for Wolff-parkinson White syndrome

Answer 2

Normally pass via AV node and his-both ventricle contract
Not everyone has an Accessory pathway–its called Ebsteins abnormality-risk factor

in WPW-conduction slowing of AV node-the acessory pathway arrives first to only the left ventricule–>then via bundle of His-creates slurred upstroke of QRS

The signal down the AV node causes AV re-entry tachycardia (AVRT)-goes back up accessory pathway and then back to AV node-tachycardia that feeds itself

other risk factors-Ebsteins abnormality
Male
Fam history
Hypertrophic cardiomyopathy, coarctation of aorta

Question 3

Epidemology of Wolff-parkinson White syndrome

Answer 3

About 0.1%/0.3% of the population. 2x more males

actual prevalence is unclear

Question 4

Symptoms of WPW syndrome

Answer 4

most of the time asymto but can activate-
signs of acute arrhythmia Paplitation, shortness of breath
chest pain
Sudden death
syncope/pre-syncope

Associations of WPW
HOCM
mitral valve prolapse
Ebstein’s anomaly
thyrotoxicosis
secundum ASD

Question 5

Signs of WPW syndrome

Answer 5

AVRT-20% have AF-irregularly irregular pulse
Very high pulse
can even have VT-

Question 6

Investigations for WPW syndroe

Answer 6

ECG—Delta wave-slurred upstroke of the QRS, broad QRS
Tachycardia
short QTc
possible AF

echocardiogram-abnormalities with Ebsteins anomaly, hypertrophic cardiomyopathy,

Question 7

Management of WPW

Answer 7

acute- Narrow complex- vagal->adenosine
Broad complex-IV adenosine, fleicanide, Amiodarone

DC cardiovert if unstable

Long term- acessory pathway ablation
or Amiodarone/fleicanide (less used