Wolff-Parkinson-White syndrome Flashcards

1
Q

definition

A

genetic condition where there is an accessory pathway causing abnormal cardiac conduction, a pre-excitation syndrome which can lead to ventricular tachycardia, cardiac arrest and death

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2
Q

who is it more common in?

A

men

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3
Q

what can it be associated with

A

congenital structural and other structural cardiac abnormalities - cardiomyopathies and valve defects such as mitral valve prolapse

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4
Q

diagnosis

A
echo 
ECG 
routine bloods/FBC
24 hour holter monitoring 
stress testing 
electrophysiology studies
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5
Q

role of echo

A

check for structural abnormalities

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6
Q

role of FBC

A

to exclude other causes, will be normal

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7
Q

role of 24 hour holter monitoring

A

to capture arrhythmias

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8
Q

role of stress testing

A

to elicit arrhythmias

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9
Q

role of electrophysiology studies

A

to show accessory pathway for ablation

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10
Q

clinical features

A
often asymptomatic 
can present with AF or atrial flutter
acute episodes 
ventricular tachycardia/cardiac arrest
acute episodes followed by polyuria
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11
Q

acute episode symptoms

A
shortness of breath
syncope 
dizziness
palpitations 
chest pain
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12
Q

ECG changes

A
delta wave 
short P-R interval 
non-specific T wave changes 
AF 
antidromic conduction 
orthodermic conduction 
ST changes  
pre-excitation
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13
Q

what is a delta wave?

A

upward slurring of R wave - makes QRS broad

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14
Q

types

A

A and B

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15
Q

type A ECG changes

A

positive delta wave and positive QRS in all leads

looks like RBBB

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16
Q

type B ECG changes

A

negative delta wave and negative QRS in V1 and V2 but positive in other chest leads - looks like LBBB

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17
Q

AF on ECG

A

> 200bpm
irregular
wide QRS due to bypassing of AVN

18
Q

antidromic conduction on ECG

A

200-300bpm

wide QRS due to accessory pathway

19
Q

orthodermic conduction on ECG

A
retrograde conduction 
200-300bpm
no P waves 
narrow QRS (<120ms) 
T wave inversion 
ST depression
20
Q

ST changes

A

occur in opposite direction to QRS complex

21
Q

pre-excitation

A

occurs during the time outside of acute episodes

22
Q

how often does atrial flutter occur?

A

7%

23
Q

how often does AF occur?

A

20%

24
Q

atrial flutter and fibrillation

A

can lead to ventricular fibrillation or tachycardia due to transfer of rapid atrial rate to ventricles via accessory pathways

25
Q

atrioventricular re-entry tachycardia

A

orthodermic conduction

accessory pathway allows electrical signal to return to atria from ventricles - normally prevented by AVN

26
Q

accessory pathway

A

bundle of kent

27
Q

treatment for asymptomatic cases

A

regular follow ups
radio-frequency ablation therapy
surgical ablation
drug treatment if unwilling/unsuitable for ablation therapy

28
Q

radio-frequency ablation

A

destroys accessory pathway

29
Q

when is surgical ablation done?

A

if radio-frequency fails or structural abnormalities are present

30
Q

treatment for atrioventricular re-entry tachycardia

A

DC cardioversion
amiodarone/flecainide
manage by SVT acute management guidelines
avoid adenosine in AF

31
Q

treatment for atrioventricular re-entry tachycardia if haemodynamically unstable

A

synchronised DC cardioversion

32
Q

treatment for atrioventricular re-entry tachycardia if haemodynamically stable

A

attempt vagal manoeuvres, adenosine and synchronised DC cardioversion

33
Q

vagal manoeuvres

A

blow into syringe and carotid sinus massage

34
Q

adenosine dosage

A

6mg
then 12mg if needed
12mg again if unsuccessful

35
Q

treatment if symptomatic

A
treat once acute episode is over 
radiofrequency ablation 
drug therapy 
anti-arrhythmic
AVN blocker
36
Q

what is contraindicated?

A

digoxin

37
Q

drug therapy for symptomatic disease

A

amiodarone
flecainide
sotalol

38
Q

implications if symptomatic

A

driving/operating heavy duty machinery

39
Q

prognosis if asymptomatic

A

risk of arrhythmia decreases with age

40
Q

what increases risk

A

family history of sudden cardiac death

short R-R interval - <250ms

41
Q

prognosis

A

sudden death occurs rarely
generally good prognosis
risk of VT or VF
radio-frequency ablation is curative