Wolff-Parkinson-White Syndrome: A Master of Disguise

Abstract

Wolff-Parkinson-White syndrome is the most common form of ventricular preexcitation and affects 1-3 per 1,000 persons worldwide. Many patients remain asymptomatic throughout their lives; however, approximately half of the patients with Wolff-Parkinson-White syndrome experience symptoms secondary to tachyarrhythmias, such as paroxysmal supraventricular tachycardia, atrial fibrillation, atrial flutter, and, rarely, ventricular fibrillation and sudden death. Patients with Wolff-Parkinson-White syndrome may present with a multitude of symptoms such as unexplained anxiety, palpitations, fatigue, light-headedness or dizziness, loss of consciousness, and shortness of breath. We report the case of a patient who presented with a plethora of symptoms related to generalized anxiety along with several confounding factors such as psychosocial stressors, chronic fatigue secondary to high physical and mental demands at work, a strong family history of anxiety, and a history of substance abuse. Keeping cardiac dysrhythmia within his differential diagnosis allowed for accurate diagnosis and treatment.

Keywords: anxiety; cardiac arrhyrthmias; chest discomfort; chest pain; elusive medical condition; palpitations; panic attacks; panic disorder; skipped beats; somatic symptoms of anxiety disorders.

Figure 1. EKG ordered in the clinic showed shortened PR interval (red arrows), delta waves (blue arrows), and wide QRS complexes (green arrows).

EKG, electrocardiogram

Figure 2. Echocardiogram of the patient with labelled chambers and valves (red arrows), which was found to be within the normal limits.