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      • Poster Session : PS 0018 ; Bioethics : “Double Trouble”: Wolff Parkinson White Syndrome and Mitral Stenosis Presenting as a Stroke in the Young

        ( Manalo Jaime Aherrera ),( Lauro Abrahan ),( Anastacio Degayo ),( Michael Agbayani ),( Michael Reyes ),( Wilfred Dee ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

        Synopsis: The Wolff Parkinson White syndrome and mitral stenosis (MS) is a unfortunate combination, with less than 15 patients reported in literature. They are individually associated with supraventricular arrhythmias and their combination may have profound hemodynamic consequences. Our case is a young male presenting with neurologic deficits who was newly diagnosed with the WPW syndrome and mitral stenosis. Case: A 25 year old male sought consult syncope, palpitations, and dizziness. On the day of admission, he experienced persistent palpitations then subsequently lost consciousness. He had a diastolic rumble, right sided hemiparesis, and dysarthria. A cranial CT scan revealed a left basal ganglia infarction. Electrocardiogram showed sinus rhythm and left atrial enlargement, a short PR interval, wide QRS complexes, and delta waves. Holter monitoring showed episodes of atrial fl utter with rapid ventricular rates. QRS complexes were narrow during other episodes of tachycardia. Echocardiogram revealed moderate mitral stenosis and a dilated LA with no thrombus. Diagnosis was WPW syndrome and rheumatic MS manifesting as a stroke in the young. Percutaneous transvenous mitral commissurotomy (PTMC) was done. He is now on regular follow up on chronic anticoagulation and medical therapy for the WPW syndrome. Conclusion: To our knowledge, this is the fi rst case of a WPW syndrome with rheumatic MS presenting as a stroke in the young who was successfully managed with PTMC for MS and anti-arhrythmics for the WPW syndrome. This unfortunate combination may have potentiated the risk for cardioembolic events which emphasizes that detection of these entities is of paramount importance. Though either of the two entities may have caused the stroke, treatment is warranted for both entities as to avoid future episodes of cardioembolic phenomena.

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