Wolff-Parkinson-White syndrome

Question 1

Define Wolff-Parkinson-White syndrome

Answer 1

Congenital abnormality which can result in supraventricular tachycardias that use an accessory pathway

It is a pre-excitation syndrome

Question 2

Aetiology of Wolff-Parkinson-White syndrome

Answer 2

The accessory pathway (bundle of Kent) is likely to be congenital

Question 3

Associations of Wolff-Parkinson-White syndrome

4

Answer 3

Congenital cardiac defects
Ebstein’s anomaly
Mitral valve prolapse
Cardiomyopathies (e.g. HOCM)

Question 4

Define Ebstein’s anomaly

Answer 4

congenital malformation of the heart characterised by displacement of septal & posterior tricuspid leaflets

Question 5

Presenting symptoms & signs of Wolff-Parkinson-White syndrome
(5 + 3 symptoms)

Answer 5

SVT may occur in early childhood
Often ASYMPTOMATIC - may be incidental finding of ECG

Symptoms
Palpitations
Light headedness
Syncope

Paroxysmal SVT may be followed by period of polyuria, due to atrial dilatation & release of ANP
Sudden death - if SVT deteriorates into VF
Clinical features of associated cardiac defects (e.g. mitral valve prolapse, cardiomyopathy)

Question 6

Investigations for Wolff-Parkinson-White syndrome

5 ECG, 1, 1

Answer 6

ECG may be normal if conduction speed of impulse along the accessory pathway matched the conduction speed down the bundle of His
Patient may be in SVT (AVRT)

Classic ECG findings
short PR interval
broad QRS complex
slurred upstroke producing delta wave

Bloods - check for other causes of arrhythmia
Echocardiogram - check for structural heart defects

Question 7

Epidemiology of Wolff-Parkinson-White syndrome

prevalence x2, age x2, both

Answer 7

Relatively COMMON
Most common of the ventricular pre-excitation syndromes
Found in all ages
More common in young
Prevalence decreases w/ age