What is the danger of ERW syndrome, the causes of development and symptomatology
The ERW syndrome (Parkinson White's syndrome or WPW) is a pathology of the heart muscle, in which non-physiological pathways of the electric pulse appear in the body. The danger of this condition is that often the WPW syndrome does not have pronounced symptoms. That is, the patient does not even know about his condition and as a result does not receive treatment, which leads to the development of severe arrhythmias.
- Causes of development
- Types and types
- The phenomenon of WPW
- WPW Syndrome
- ECG with WPW syndrome
- Symptoms, consequences
- Course of pathology
- Methods of diagnosis of the syndrome
- Therapy of WPW Syndrome
According to medical statistics, the prevalence of the syndrome among cores is only 5-2% of cases. Often, it is diagnosed in males, and under the age of 20 years, including in children. In the older generation, the syndrome is rare. This heart disease is insidious in that it causes serious heart rate failures, which is life-threatening. Pathology requires specific treatment.
Note! It was found that Wolff Parkinson White syndrome often has a genetic nature. If this form is found, a mutation in one of the genes is found..
In a normal state, cardiac excitation passes through the physiological pathways from the right atrium to the ventricles. For a certain time, the impulse stops in the cell mass between the chambers in the atrioventricular node. If the ERW syndrome develops, the excitement passes around the node along the bundle of Kent, which is an additional route. Since there is no mandatory physiological slowing of the pulse, early activation of the ventricles occurs.
As you mature, the conductivity of the Kent beam worsens, so the symptoms of the syndrome may disappear. Often the pathology is not combined with other heart diseases. In some cases it occurs in combination with:
- the Ebstein anomaly;
- prolapse of the mitral valve.
It is worth noting that in our country, ERW syndrome is the cause of release from emergency service with an explanation of "B-category".
Causes of development
The reasons for the development of pathology most experts consider the preservation of additional atrioventricular compounds as a result of an inadequate process of cardiogenesis. In this case, the incomplete regression of muscles passes during the development of fibrous rings.
In the perinatal period, additional muscle pathways are present in each fetus, and this is considered the norm in the first stages of development. As they grow, they disappear, thinning out and shortening. This should normally occur before the 20th week of gestation. If this did not happen, then the presence of these additional pathways is the basis for the development of WPW syndrome in the child. But even so, the disease can manifest itself not in infancy, but later.
Types and types
In medicine, there are 2 concepts that have different manifestations: the syndrome and the phenomenon of WPW.
The phenomenon of WPW
It is peculiar for him:
- ECG signs of passing electric impulses along auxiliary paths.
- Pre-excitation of the ventricles is present.
- With all this, there are no symptoms. This condition is dangerous, because the patient does not receive treatment.
In a third of patients, the phenomenon of WPW is determined by accident during screening examinations or preventive examinations. But this does not mean that this pathology can be left without attention. In some situations, after a strong emotional unrest or the impact of another provoking factor, an unexpected manifestation may occur. The phenomenon of WPW causes sudden death in% of such deaths.
WPW syndrome has symptoms, the most common of these is tachycardia.
There is such a division by types:
- Syndrome WPW (VPV) type A, with its additional muscle fibers have such locations:
- on the left / right atrioventricular junction;
- on aortic-mitral fibrous articulation;
- on the right / left auricle.
- WPW syndrome type B is associated with Kent bundles, that is, muscles that have the same structure as the physiological node. They are able to flow into the myocardium from the right ventricle or into the right leg of the bundle of His.
According to medical manifestations, there are different types of manifestation of the syndrome:
- Manifesting. It is characterized by the stable presence of delta waves, sinus heart rhythm, tachycardia.
- Intermittent WPW syndrome, it is also referred to as WPW syndrome. The key characteristics are transient transient delta waves, sinus rhythm, verified tachycardia.
- The latent (retrograde) WPW-ECG syndrome in WPW syndrome of this type does not show any signs of the disease, but there are episodes of AV tachycardia.
Types of morphological changes in the heart:
- With additional AV fibers of different directivity.
- With differentiated AV fibers of muscles.
ECG with WPW syndrome
The syndrome of WPW when tested on an ECG will manifest itself by such changes:
- The reduction of the interval P-Q is less, 2 s. This leads to a more intense impulse from the atria to the ventricles.
- The QRS complex becomes wider and deformed. In its beginning, there is a delta wave with a gentle slope. It is she who shows that the impulse passed along the side path.
If WPW syndrome is noticeable, then its electrocardiographic symptoms will be permanent or periodic. For latent syndrome, the detection of ECG changes in paroxysmal arrhythmias is characteristic.
The syndrome can not for a long time show itself, only at times making itself felt. His manifestation can occur at any age. Often in men, this occurs in adolescence to 20 years, and in women - during pregnancy. Specific signs of the syndrome does not, one of the most likely is a paroxysmal arrhythmia. This symptom is characteristic for 70% of cases when a pathology is detected at this age.
As for children under 3 years, the syndrome can give such a manifestation as paroxysmal tachycardia, which can lead to the development of acute heart failure.
In the adolescent period, WPW syndrome manifests itself unexpectedly, but it is easier to tolerate. Often there are attacks of tachycardia with an increase in heart rate with an upper limit of 320 (always more than 200) beats per minute. The provoking factors are:
- physical exercise;
- reception of alcohol.
But not always for such manifestation there are reasons, at least visible.
Attacks that last from 2-3 seconds to 2-3 hours, will give such manifestations:
- Heart pains.
- Arrhythmia of the heart - the syndrome will give it in a calm state, and with active movements.
- Dizziness, fainting.
- Lack of air.
- There will be a noise in your ears.
- The patient throws into cold sweat.
- Pale / cyanotic skin.
- Cyanosis of the fingers, nail plate, nasolabial triangle.
- Decrease in pressure.
- Pain in the abdomen, nausea, vomiting.
You can stop the attack by taking specific medications, sometimes it stops arbitrarily.
The consequences of such attacks are different - it all depends on the duration. Atrioventricular and atrial tachycardia occur in 80% of cases, atrial fibrillation and atrial fibrillation in 20%.
If the attacks of tachycardia occur systematically, they provoke the aggravation of heart failure, various kinds of stagnation in the liver, the growth of the size of this organ. The consequences are and arrhythmias of the ventricles, in particular, an increase in the number of extrasystoles and, as a result, the development of extrasystole..
Note! Disability in WPW syndrome is given in a complex course of the disease. In doing so, they give the second group..
Course of pathology
The syndrome of ERW has such variants of the current:
- Asymptomatic - in 30-40% of cases.
- Light - for this form is characterized by a short tachycardia, the duration of attacks - no longer than 20 minutes. They die down without medication.
- Moderately severe - with this variant, attacks last 3 hours. Tachycardia does not go away without taking medication.
- Heavy current. Crises last more than three hours, flutter, extrasystoles, inconsistent atrial contraction. It is impossible to stop the attacks with medicine. They are very dangerous: about 2% result in death. If the course of WPW syndrome is characterized by such manifestations, it is recommended that the operation be performed.
Methods of diagnosis of the syndrome
The main diagnostic technique is the ECG. To diagnose even hidden forms, a 12-lead study will be required. The heart rate can exceed 220 beats per minute, sometimes even reaches the extreme limit - 360. The ECG shows a shortened P-R interval, an increase in the QRS complex.
The most accurate method of diagnosis is transesophageal electrostimulation. Through the esophagus, an electrode is placed on the heart, it forces the heart to contract in the right rhythm. When the frequency reaches 100-150 bpm, the cessation of the operation of Kent beams is determined. This helps to prove with 100% certainty that there are additional ways to conduct an impulse.
Sometimes other methods are used, namely:
- Daily mounting. Such a procedure is necessary for diagnosing the transitional form, it requires a certain time to monitor the patient's condition.
- Ultrasonic diagnosis of the heart with a dopplerogram. It makes it possible to identify the heart and vascular malformations.
- Endocardial EFI - catheters are inserted into the muscle through the veins. This method makes it possible to detail the areas and the number of anomalous paths of impulses.
Therapy of WPW Syndrome
The treatment of WPW syndrome is selected in accordance with the severity of the course, clinical manifestations and progression. Also it is necessary to consider, whether the illness has given such complication, as heart failure. If there are no symptoms, then treatment is often not carried out.
As for drug therapy, the patient will be treated with anti-arrhythmic drugs, which will have to be taken throughout life. It is impossible to start reception of such means independently, as many of them have clear contraindications that can significantly affect the patient's condition and aggravate course of pathology.
In severe cases, hospitalization is often necessary, among anxiety symptoms:
- paroxysmal tachycardia;
- progression of heart failure;
- other burdened symptoms.
The best radical solution for the treatment of pathology is surgery - radiofrequency catheter ablation. The prerequisites for such intervention are the lack of response to medication therapy. In 95% of cases, this treatment is highly effective: it is capable of preventing not only death, but also disability. Cases of syndrome return occur in 5% of patients.
WPW syndrome is a rare, often congenital heart disease. It is capable of not manifesting itself for years, thus not forcing a person to be examined once more. The danger of it is that it leads to the development of dangerous cardiac pathologies that have a lethal outcome... .