[Coexistence of WPW syndrome, coronary disease and segmental disorders of myocardial contraction. Diagnostic difficulties. Description of a case].
A 61 years old patient with Wolff-Parkinson-White's syndrome, and hypertension was admitted to the CCU, because of the first episode of substernal chest pain. ECG was deformed by Wolff-Parkinson-White's syndrome, type B, with accessory pathway located on the right side, without evolution. Serum enzymes remained low. Echocardiography showed akinesis of the posterior wall and hypokinesis of the lateral wall (the same contraction disorders were described in previous echocardiographical examination 5 years ago), it was observed that the first portion of myocardium to contract was the base of the right ventricle. To elucidate the etiology of the contraction disorders, scintigraphy of the heart, using Thallium 201, was performed, showing normal perfusion of the myocardium. To illustrate the dependence of the contraction disorders and abnormal depolarization pattern of the heart, echocardiographical examination was repeated, confirming the previous results, then 100 mg of Ajmaline was given to the patient intravenously, and echocardiographical examination was continued. Administration of the drug caused antidromic atrioventricular re-entrant tachycardia during which the lateral wall of the heart had been contracting properly. This case shows contraction disorders of the heart caused by the abnormal depolarization pattern, resulting from the presence of accessory pathway. It also illustrates the diagnostic difficulties in patients with Wolff-Parkinson-White's syndrome and suspected myocardial infarction, at the same time showing that scintigraphy of the heart might be very helpful in such patients. This case confirms the usefulness of echocardiography for localization of the accessory pathway.
Zarebiński
M
M
I Kliniki Instytutu Chorób Wewnetrznych CSK WAM, Warszawie.
Krupienicz
A
A
Marciniak
W
W
Ostrowski
M
M
D003327:Coronary Disease / Q000150:complications* / Q000175:diagnosis; D004452:Echocardiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis; D013794:Thallium Radioisotopes; D014927:Wolff-Parkinson-White Syndrome / Q000150:complications*
D013794:Thallium Radioisotopes
Współistnienie zespołu WPW, choroby wieńcowej i odcinkowych zaburzeń kurczliwości mieśnia serca. Trudności diagnostyczne. Opis przypadku.