archer cardio 3 - senor

[ArchivalUser]

A 40 year-old man presents to office for routine follow-up visit. His past medical history is significant for hypertension for which he is on Hydrochlorthiazide. He denies any chest pain, palpitatations, shortness of breath or syncope. He is a journalist by occupation. A routine EKG is obtained and is shown below:
http://ccsworkshop.com/blog/question-of-the-week-225/

Which of the following is the most appropriate managment of this patient?
A) Beta-blocker
B) Catheter ablation
C) Diltiazem
D) Observation
E) Electrophysiological studies

[ArchivalUser]

Catheter ablation....WPW Syndrome

[ArchivalUser]

drintx : you are right the graphy shows Delta wave and short PR = WPW

But the point is pt is Asymptomatic and he doesnt have any complains and he is coming to you for a routine visit. So Catheter ablation is not advised. Direct catheter ablation is ususally done when the pt is symptomatic or associated AF.

So I would go with Observation and routine follow up OR EP studies.

Misshyd we need you to throw some light on this area.

[ArchivalUser]

Ok I think answer is E....Skip to the end of the page...to Current guidelines & conclusions....it says we need to further assess these patients for risk stratification....

http://circ.ahajournals.org/content/112/14/2201.full

[ArchivalUser]

it is obviously WPS, and he is assymptomatic which would normally be observed, but is just seeing the delta wave enough on ekg to dx the disease or electrophysiology has to confirm , which will confirm it but is it the protocol

[ArchivalUser]

drintx : THis is what I found from the article you pasted. I just skipped directly to management and recommnedation portion. I found this. what do you think ? please comment.

When confronted with the asymptomatic patient showing a WPW ECG, the first step is to perform the noninvasive tests outlined above to recognize the low-risk patient. For the low-risk patient, no measures are advised other than an explanation to the patient of the ECG findings. It is advisable to give the patient a copy of his or her ECG and a short note about the fact that the WPW syndrome is present to prevent the misdiagnosis of myocardial infarction and to explain the basis of cardiac arrhythmias in case they develop later.

[ArchivalUser]

observation

[ArchivalUser]

wpw...beta blocker

[ArchivalUser]

supandi, there are no s/s at all in this patient
E is tempting coz its the best test for wpw but the Dx is already done just with the EKG so id just observe him if he were my pt...
btw slurring of the wave is a real beauty in this one in the link.

gl