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21 y/o male referred for tachycardia

A 21 years old male was referred for evaluation of tachycardia. He experienced episodes of palpitations and nausea over the past few months. Symptoms always had sudden onset and sudden termination. The episodes lasted between 5 and 30 minutes.

There was no history of known heart disease. No meds. No family history of cardiovascular disease. The patients reported he does a lot of sports without any complaints thus far.


The tachycardia had been documented by the referring physician:


Regular narrow complex tachycardia, 260 bpm, P waves following QRS complexes.

Paroxysmal SVT.


Upon consultation, we performed echocardiography and an ECG.

This is the ECG:


Sinus rhythm with sinus arrhythmia and preexcitation (pos. Delta wave in I, short PR interval of varying degree). So, Wolff-Parkinson-White syndrome with orthodromic reentry tachycardia.


Echocardiography was surprising:


Quite large offset of the AV valves (i.e. the mitral and tricuspid valve insert far away from each other at the inter ventricular septum). Right ventricle (RV) is atrialized (small due to the aberrant position of the tricuspid valve). This is Ebstein´s anomaly. Accessory pathways are quite common in Ebstein´s, mostly right sided pathways.


We scheduled the patient for EP study and ablation. Once performed, we will report our findings within the following blog entries. So stay tuned.


Further information on Ebstein´s anomaly can be found at

https://www.ncbi.nlm.nih.gov/books/NBK534824/

or

http://www.pted.org/?id=ebstein1


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