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Wolf-Parkinson-White alternans diagnosis unveiled by adenosine stress test
1Division of Cardiovascular Diseases, Farmington Heart Center, Farmington, NM, USA. khouzamrami@yahoo.com
Insights
Wolf-Parkinson-White syndrome can mimic heart attack on ECGs. This case highlights how intermittent preexcitation can be detected during stress testing, confirming the diagnosis.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Atypical chest pain presentation necessitates thorough diagnostic evaluation.
- Electrocardiogram (ECG) interpretation is critical for diagnosing cardiac conditions.
Observation:
- A patient initially diagnosed with left bundle-branch block and old infarct on ECG.
- Subsequent normal ECG by a cardiologist prompted further investigation.
- Transient preexcited beats observed during an adenosine nuclear stress test.
Findings:
- Diagnosis of Wolf-Parkinson-White (WPW) syndrome confirmed by intermittent preexcitation during stress testing.
- WPW syndrome can present with ECG findings mimicking other cardiac abnormalities, such as pseudoinfarct patterns.
- Preexcitation alternans observed during adenosine stress test.
Implications:
- Highlights the importance of considering WPW syndrome in atypical chest pain presentations with misleading ECGs.
- Adenosine nuclear stress testing can be valuable in diagnosing conditions with intermittent ECG abnormalities.
- Accurate diagnosis of WPW syndrome is crucial to prevent misdiagnosis and ensure appropriate management.
Abstract:
The case of a 41-year-old woman who presented to her primary care physician with atypical chest pain was reported. An electrocardiogram (ECG) was performed in his office and the patient was told she had left bundle-branch block and an old infarct. The patient was very concerned and referred to cardiology for further evaluation/testing. An ECG at the cardiologist's office was normal. The cardiologist however suspected the ECG performed at the primary care physician office to be preexcitation (Wolf-Parkinson-White). During an adenosine nuclear stress test, intermittent preexcited beats occurred transiently to confirm the diagnosis of Wolf-Parkinson-White. Wolf-Parkinson-White can mimic multiple other ECG changes including a pseudoinfarct pattern and hence be misleading. The figure of the unique ECG, during the adenosine stress test, of intermittent preexcited (preexcitation alternans) complexes is included.
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