Wolff-Parkinson White (AVRT)

Question 1

AVRT means an a____ pathway exists for impulse conduction, not re-entering through the ___

Answer 1

accessory
AVN

Question 2

AVRTs are often h____

Answer 2

hereditary

Question 3

Wolff-Parkinson White is when there is an accessory pathway for conduction called the…

Answer 3

Bundle of Kent

Question 4

Wolff-Parkinson White (WPW) is a p__-______ syndrome

Answer 4

pre-excitation
(excites ventricles earlier than typical pathway)

Question 5

What are symptoms of WPW?

Answer 5

Palpitations
Dizziness
Dyspnoea

Question 6

How is WPW diagnosed?

Answer 6

ECG:
slurred Delta waves (QR upwards)
Short PR interval (under 120ms)
Wide QRS (over 120ms)

Question 7

What is 1st line treatment for WPW?

Answer 7

Valsalva maneuver (blow into syringe against resistance) to stimulate vagus nerve to slow heart rate and disrupt re-entrant circuit

Carotid sinus massage:
Pressure applied at carotid sinus (where common carotid bifurcates to internal and external). Increasing pressure on these baroreceptors can also stimulate vagus nerve.

Question 8

What is 2nd line treatment for WPW?

Answer 8

IV Adenosine

Warn patient will “feel like dying” as conduction will temporarily cease!

Start 6mg. If unsuccessful then do 12mg, then further 12mg

Question 9

What is the 3rd line treatment for WPW?

Answer 9

Consider surgical radiofrequency ablation of bundle of Kent