Prasetyo RB*, Rosalinda V*, Gerisa B*

General Practioner of Damanhuri Hospital Barabai, Kalimantan Selatan

WPW Syndrome, A Rare case in Type C Hospital

Background: Wolf Parkinson White Syndrome is a relatively common heart condition that
causes the heart to beat abnormally fast for periods of time. WPW is a cardiac conduction
disorders an extra electrical connection in the heart. The diagnosis of WPW syndrome is
reserved for patients who have both pre-excitation and tachyarrhytmias. The incidence of
manifest pre-excitation or WPW patern on ECG tracings in the general population is 0,1% to
0,3%.
Case report: A 61 years old male come to Damanhuri Hospital with dispneu since 2 month
ago and increase since days ago. He also felt palpitation and sincop 2 hours before
admission, oedem in both of legs and ascites since 2 months ago. He also have history of
chronic heart disease before but not in routine medication. His blood pressure was 110/80
mmHg, heart rate 186 bpm, respiration was 32 tpm. Physical examination revealed
increased of JVP, gallop and rales in 2/3 basal of pulmonary, and oedema in both of lower
legs. Chest X ray shown cardiomegaly and dilatation of aorta. ECG revealed RAD, RBBB
and RVH. In emergency departement, his hemoglobin was 12.9 g/dl, ureum 70 mg/dL,
creatinin serum 1.9 mg/dL, other laboratory finding was Natrium 115,7 and kalium 3.45.
Discussion: Diagnosis of WPW syndrome is confirmed by characteristic electrocardiogram
changes, which include a delta wave, short PR interval and widenes QRS complex.
Symptoms of WPW such characterized by hyperviscosity simptom such as headache, visual
disturbance, cerebrovascular accident, myocard infark or other over trombothic event. The
current treatment guidleines reccomendation phlebotomy with or without cytoreductive
therapy. Main goal of secondary PV is to maintain hematocrit level <45% to reduce the risk
of thrombosis, but in DORV patient, there are no studies defining optimal hematocrit level.
The current clinical practise is to phlebotomize patients with DORV and secondary PV when
they present with symptomatic hyperviscosity.
Conclussion: Secondary PV can increased incidence of cerebrovascular disease.
Diagnosis is based on clinical history, exercise testing and laboratory finding. We perform
phlebotomy for patient to reduce hematocrit level to decrease cerebrovascular disease or
other hperviscosity disease.
 
Keywords:
Polycythaemia vera, Double Outlet Right Ventricular, Phlebotomy
 

Gejala WPW syndrome sama dengan tachyarithmia lain seperti palpitation, sesak, hingga pingsan.
The current treatment guidelines recommendation are synchronized cardioversion (1a) or medicatto