Asymptomatic Wolff-Parkinson-White Syndrome: Incidental EKG
History of present illness:
A 38-year-old male presents to the emergency department for a minor trauma evaluation after falling off a bicycle at a moderate rate of speed. The patient was not wearing a helmet when he hit his head with unknown loss of consciousness. Focused assessment with sonography for trauma (FAST) exam and head computed tomography (CT) were negative. Routine electrocardiogram (ECG) showed sinus rhythm with pre-excitation indicative of Wolff-Parkinson-White Syndrome (WPW). The patient confirmed a previous diagnosis of WPW, but had not previously followed up with a cardiologist.
The ECG shows slurred up-stroking of the QRS complexes characteristic of a delta wave. The PR interval is normal; however, the QT interval is greater than 110ms.
Wolff-Parkinson-White Syndrome (WPW) is a frequently encountered macro-reentrant arrhythmia characterized by a shortened PR interval less than 120ms, prolonged QRS greater than 120ms with an up-stroking QRS complex (delta wave), and occasional ST abnormalities.1 The incidence is reported to be 0.9%-3% of the general population and most diagnoses are made on routine EKGs.2,3 WPW is thought to be caused by abnormalities of conduction through the ac