A 21-year-old male who is otherwise healthy, has no known medical problems, and presents to his primary care provider with a chief complaint of heart palpitations. He explains that they first started to occur three months ago, when he was drinking numerous energy drinks, and incredibly stressed studying for finals.
However, since then he has discontinued consumption of all caffeinated beverages and energy drinks, yet he reports two additional episodes of heart palpitations. One of which was associated with chest pain while the other was accompanied with lightheadedness. An EKG was taken in the office and reveals a short PR interval with a slurred appearance to the upstroke of the QRS complex.
Which of the following is the preferred long-term treatment of choice?
A. Medical management with PO flecainide
B. Percutaneous coronary intervention
C. Medical management with PO propafenone
D. Radiofrequency catheter ablation
E. Medical management with PO amiodarone
The above scenario depicts an individual with Wolff-Parkinson-White (WPW) syndrome as can be deferred by the classical EKG pattern of a shortened PR interval (less than 0.12 seconds), and widening of the QRS complex with a slurred appearance to the upstroke of the QRS complex, more commonly referred to as a delta wave.
The preferred long-term treatment to prevent recurrent symptomatic arrhythmias is radiofrequency catheter ablation; therefore the correct answer is D.
Here, we are given a young patient who is otherwise healthy. But, now he’s complaining of palpitations. We are also given the associated symptoms of chest pain and lightheadedness.
Finally, we are given the EKG.
This is enough information to formulate the most likely diagnosis. But, notice how a good question won’t stop there. Instead, we are asking you to go a step further, and answer how you would manage this patient.
After sharing the correct answer, it's now time to discuss why the others aren’t the best answer choice. Knowing why an answer choice is correct is just as important as to why an answer choice is incorrect.
This is crucial to your understanding of medicine.