Monday, February 9, 2015

Study group discussion: Wolff-Parkinson-White (WPW) and increased QRS interval

Causes of increased QRS interval?
BBBs (Bundle branch block)
Electrolyte abnormalities
WPW syndrome
Medications like:
Procainamide
Tricyclic antidepressants


How does BBBs cause increase in QRS interval?
Bundle of his splits into two main divisions.. Right and left bundle branch.
So block within any one of them, would cause increased time for the depolarization wave to spread along the right to left ventricle. Hence, increased QRS interval.

What is the triad of WPW syndrome? Short PR interval
Delta wave
Wide QRS

Delta wave is initial upslurring in the beginning of QRS complex

What is the treatment for WPW syndrome?
Procainamide
Heart ablation

Both are correct! Though for initial treatment we would give procainamide.
Catheter ablation is more of long term approach!

Which drugs are to be avoided in WPW syndrome?
There's the mnemonic ABCD: Adenosine, Beta blockers, Calcium channel blockers, Digoxin

About the drugs to be avoided: They are avoided because if normal is blocked all impulses pass through accessory tract. This worsening the condition.

What are the complications for WPW syndrome?
Atrial fibrillation and atrial flutter. Hence it has to be ablated.

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