6/12/2023 0 Comments Wpw ecg findings![]() ![]() Chest X-ray: to rule out other (non-cardiac) causes.Relevant laboratory investigations include: Type B (right-sided): negative delta wave in leads V1 and V2īlood tests may be useful in ruling out other (non-cardiac) causes of palpitations.Type A (left-sided): positive delta wave in the precordial leads (V1 – V6).Type A WPW pattern is a left-sided accessory pathway and type B WPW pattern is a right-sided accessory pathway.ĮCG features will be different depending on whether a person has type A or type B WPW pattern: 7 Wolff-Parkinson-White syndrome can also be subdivided depending on which side the accessory pathway runs in the heart. ECG showing the key features of Wolff-Parkinson-White syndrome including a short PR interval, delta waves and broad QRS complexes. Prominent R waves in V1-3: this mimics a posterior infarctionįigure 2.Incongruous ST segment and T waves changes.Key features of WPW on an ECG in sinus rhythm include: Other conditions that may present similarly include valvular disease, Ebstein’s anomaly (a congenital malformation of the tricuspid valve) and hypertrophic cardiomyopathy. ![]() ![]() Atrioventricular nodal re-entry tachycardia (AVNRT).The main differential diagnoses for Wolff-Parkinson White syndrome are other tachyarrhythmias: 5 Symptoms do not usually have any precipitating factors, however, episodes may be triggered by strenuous exercise, alcohol or caffeine. The frequency of symptoms also varies considerably. The duration of these symptoms varies from person to person and can range from seconds to hours. 4įor more information on history taking in patients with palpitations, see the Geeky Medics OSCE guide to palpitations history taking. Other features may include chest pain, shortness of breath and sweating. Typical symptoms of tachyarrhythmias include: 4 Some patients may be asymptomatic and only diagnosed following a routine ECG. The clinical features of Wolff-Parkinson-White syndrome are caused by the associated tachyarrhythmias. WPW Syndrome is also associated with congenital heart disease, such as Ebstein’s anomaly. This genetic mutation is autosomal dominant. However, a small percentage of cases are thought to be due to an inherited mutation in the PRKAG2 gene. Wolff-Parkinson-White Syndrome most commonly presents in males aged 30-40 years. Unlike normal conduction pathways in the heart, conduction through the accessory pathway in WPW is not regulated by the AV node and can lead to tachyarrhythmias (the heart beating too fast). Conduction through a left-sided accessory pathway leading to pre-excitation in WPW. The accessory pathway in Wolff-Parkinson-White Syndrome is sometimes referred to as the ‘ bundle of Kent’. This will affect the changes seen on the ECG (see investigations section). Anterograde conduction by itself is rare.Īdditionally, the accessory pathway may be left-sided or right-sided. 15% of patients), conduction moves in a retrograde manner only. In most patients, conduction can move both anterograde (from the atria to the ventricles) and retrograde (from the ventricles to the atria). The location and conduction through the accessory pathway varies between individuals. This, in addition to normal electrical conduction through the AV node, leads to ‘ double excitation’ of the ventricles. The accessory pathway enables electrical conduction to bypass the AV node and stimulate the proximal ventricles prematurely (pre-excitation). In Wolff-Parkinson-White, an accessory pathway leads to stimulation of the ventricles. You might also be interested in our medical flashcard collection which contains over 1000 flashcards that cover key medical topics. ![]()
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