DIFFICULTIES IN DIAGNOSING MYOCARDIAL INFARCTION IN A PATIENT WITH WOLFF-PARKINSON-WHITE PHENOMENON

Background. The Wolf-Parkinson-White phenomenon is an electrocardiographic phenomenon caused by accessory atrioventricular pathway with ventricular preexcitation. The Wolff-Parkinson-White pattern can mimic myocardial infarction and be the cause of its overdiagnosis. At the same time, it can mask the true myocardial infarction.

The aim.  To present the diagnostic algorithm for suspected myocardial infarction in a patient with Wolf-Parkinson-White phenomenon.

Case report. A clinical case demonstrates the difficulties of diagnosis of myocardial infarction in a patient with Wolf-Parkinson-White phenomenon. A 47-year-old patient presented with chest pain radiating to his left arm. Electrocardiogram revealed a negative delta wave in leads II, III, and avF with ST segment elevation in these leads. There were positive delta waves and ST depressions and T inversions in lead I, aVL, V1-V6. Conclusion about inferior myocardial infarction with ST elevation was made. Thrombolytic therapy was performed. There was no dynamic on the electrocardiograms. The patient was transported to the Percutaneous Coronary Intervention center. Coronary angiography did not show any coronary artery stenosis. The troponin I level was normal and repeat troponin test was normal too. Echocardiography did not reveal disturbance of local contractility.

The results of the examination made it possible to exclude a myocardial infarction in the patient with Wolf-Parkinson-White phenomenon. Electrocardiography indicates a left-sided posteroseptal accessory pathway. The patient has a Wolf-Parkinson-White phenomenon, as there are no attacks of paroxysmal tachycardia.

Conclusion. This case illustrates the difficulties of diagnosis of myocardial infarction in a patient with the Wolf-Parkinson-White phenomenon and importance of assessment ECG dynamic, troponin, coronarography and echocardiography.

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