Cor Vasa 2024, 66(1):80-83 | DOI: 10.33678/cor.2023.081
Differentiating between Exercise-Induced ST-Segment Abnormalities Secondary to Wolff-Parkinson-White (WPW) Syndrome and Acute Myocardial Infarction
- Medical Faculty of Airlangga University - Dr. Soetomo General Hospital, Surabaya, Indonesia
Background: Exercise stress testing (EST) can cause false-positive diagnoses of myocardial infarction (MI) in individuals with Wolff-Parkinson-White (WPW) syndrome. Case: A 30-year-old male had a history of palpitation and near syncope 2 months before examination. The pre-test probability (PTP) score was 1% and baseline ECG showed typical features of WPW syndrome. Additionally, risk stratification was performed with EST using the Bruce protocol. Persistent ventricular preexcitation (VPE) with upsloping 3.0 mm ST-segment depression was found in precordial leads at the fourth stage, while the aVR lead showed a 3.0 mm ST-segment elevation.
Conclusion: Understanding the primary ST-T abnormalities was essential to differentiate MI from abnormal repolarization in individuals with WPW syndrome. Initial identification based on clinical characteristics and PTP risk scoring is crucial for distinguishing the cause of ST-T wave changes. Low-risk patients with exercise- -induced ST changes in the context of WPW syndrome should be considered to have received a false-positive exercise test result. A holistic method by clinical investigation, PTP risk scoring, and the identification of ECG characteristics are needed to distinguish the changes during EST in the presence of preexcitation.
Keywords: Exercise stress test, Preexcitation syndrome, Wolff-Parkinson-White syndrome
Received: June 22, 2023; Revised: October 17, 2023; Accepted: October 29, 2023; Prepublished online: June 2, 2012; Published: March 5, 2024 Show citation
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