About preexcitation syndrome

What is preexcitation syndrome?

General Discussion

Wolff-Parkinson-White (WPW) syndrome is a rare congenital heart disorder involving irregularities in the electrical system of the heart. In individuals with WPW syndrome, an abnormal alternate electrical pathway (accessory pathway), exists between the atrium and the ventricle, resulting in abnormal heartbeat rhythms (arrhythmias) and faster than normal heartbeats (tachycardia). The normal heart has four chambers. The two upper chambers are the atria and the two lower chambers are the ventricles. Within the right atrium of a normal heart is a natural pacemaker that initiates and controls the heartbeat. The electrical stimulus travels from the pacemaker (sinoatrial or SA node) to the ventricles along a specific pathway consisting of conducting tissue and known as the AV (atrioventricular) node. The extra electrical pathway in individuals with WPW syndrome bypasses the normal route and causes the ventricles to beat earlier than normal (preexcitation) and can allow electrical impulses to be conducted in both directions (i.e., from the atria to the ventricles and from the ventricles to the atria).

What are the symptoms for preexcitation syndrome?

The symptoms of preexcitation syndrome are varied, but they can be grouped into two categories: those that affect your heart and those that affect your brain.

  • Heart-related symptoms include a fast heartbeat and skipped beats. The most common symptom is a rapid heartbeat—this can occur when you're at rest or when you are exercising. If you have preexcitation syndrome, this rapid heartbeat can cause Palpitations or a feeling of your heart beating too fast or too hard.
  • Another heart-related symptom is atrial fibrillation (AFib). AFib is a condition in which the upper chambers of your heart (the atria) beat irregularly, which can lead to blood clots forming and traveling through your bloodstream. This can cause stroke or other serious health problems if not treated properly.
  • The exact cause of preexcitation syndrome is unknown. The condition may be genetic or related to other conditions, like long QT syndrome or Wolff-Parkinson-White syndrome.
  • Seizures
    • Cardiac arrhythmia
    * Palpitations (a feeling of fluttering or pounding in your chest),
    * Chest pain or discomfort,
    * Lightheadedness or Dizziness, and
    * Fainting episodes.
Symptoms
Fast heartbeat,Irregular or skipped heartbeats (also called extrasystoles),Shortness of breath, especially when exercising or at rest,Chest pain (angina) when exercising or at rest,Heart Palpitations (Irregular heartbeat that can feel like fluttering, pounding, or racing),Lightheadedness and Fainting
Conditions
SVT,Ventricular preexcitation
Drugs
Beta blockers such as metoprolol (Lopressor, Toprol-XL),Propranolol (Inderal, Innopran XL),Atenolol (Tenormin)Aspirin,Ibuprofen

What are the causes for preexcitation syndrome?

Preexcitation syndrome is a condition in which the electrical impulses that travel through the heart are conducted through an abnormal pathway. This results in an earlier than normal activation of the ventricles, or lower chambers, of the heart.

  • Preexcitation syndrome is a condition where there is a delay in the ventricular contraction and, therefore, atrioventricular (AV) conduction. This leads to an abnormal heart rhythm called preexcitation.
  • The causes of preexcitation syndrome are unknown, but it is more common in children than adults.
  • The main cause of preexcitation syndrome is Wolff-Parkinson-White syndrome (WPW), which is a form of congenital heart disease.
  • In WPW, an extra electrical pathway called an accessory pathway exists between the atria and ventricles.
  • The accessory pathway is responsible for causing the early activation of ventricular contraction and abnormal conduction through this pathway.
There are a number of causes of preexcitation syndrome. Some of the most common include:

1. Heart diseases—such as cardiomyopathy or heart valve problems

2. Fainting spells or syncope

3. Certain medications like stimulants, painkillers and others

4. Electrolyte imbalances—such as low potassium levels, high calcium levels and high sodium levels

-Use of stimulant drugs such as amphetamines or cocaine

-Stress and anxiety disorders like panic attacks or posttraumatic stress disorder (PTSD)

-Cardiac arrhythmias like atrial fibrillation or atrial flutter

Symptoms
Fast heartbeat,Irregular or skipped heartbeats (also called extrasystoles),Shortness of breath, especially when exercising or at rest,Chest pain (angina) when exercising or at rest,Heart palpitations (irregular heartbeat that can feel like fluttering, pounding, or racing),Lightheadedness and fainting
Conditions
SVT,Ventricular preexcitation
Drugs
Beta blockers such as metoprolol (Lopressor, Toprol-XL),Propranolol (Inderal, Innopran XL),Atenolol (Tenormin)Aspirin,Ibuprofen

What are the treatments for preexcitation syndrome?

Preexcitation syndrome is a heart condition that causes the atria to beat faster than normal, which means that the ventricles have to beat slower than normal.

  • There are two primary treatments for preexcitation syndrome: medication and surgery.
  • Medications used in these cases include beta-blockers and calcium channel blockers, which slow down your heart rate so that it's more in line with what it should be.
  • You'll likely need to take these medications for the rest of your life, but they're fairly safe and effective.
  • Surgery is also an option for people with preexcitation syndrome who suffer from symptoms like palpitations or shortness of breath that don't respond well to medication.
  • Surgery can help treat these symptoms by slowing down your heart rate after you've gone through some sort of procedure called ablation, where they burn off small areas on your heart tissue.
  • There are several other treatment options for preexcitation syndrome, like pacemaker therapy.
  • When this is not an option, doctors may recommend an ablation procedure to correct the problem with your heart's electrical system. This involves inserting a catheter through a small incision in your leg and running it up to your heart while you're under anesthesia.
  • The doctor can then use high-frequency radio waves to destroy abnormal pathways that cause abnormal electrical signals, which stops the extra beats from happening.

Symptoms
Fast heartbeat,Irregular or skipped heartbeats (also called extrasystoles),Shortness of breath, especially when exercising or at rest,Chest pain (angina) when exercising or at rest,Heart palpitations (irregular heartbeat that can feel like fluttering, pounding, or racing),Lightheadedness and fainting
Conditions
SVT,Ventricular preexcitation
Drugs
Beta blockers such as metoprolol (Lopressor, Toprol-XL),Propranolol (Inderal, Innopran XL),Atenolol (Tenormin)Aspirin,Ibuprofen

What are the risk factors for preexcitation syndrome?

The risk factor for preexcitation syndrome is having an underlying heart defect—but this doesn't mean you'll definitely get it.

  • The most common cause of preexcitation syndrome is Wolff-Parkinson-White syndrome, which is present in about 50% of cases.
    •In this condition, there's an extra electrical pathway in your heart that allows some of the electrical impulses to travel from your atria to your ventricles (the chambers of your heart) before they're supposed to go through the AV node (the part of your heart that regulates how fast or slow each beat will be).
    •This means there's usually no problem with your heart rate or rhythm when you're at rest, but when you're exercising or doing other things that increase your heart rate, you may experience symptoms like dizziness or palpitations (an irregular heartbeat).
    •The risk factors for preexcitation syndrome are the same as the risk factors for atrial fibrillation, which is often a precursor to preexcitation syndrome.
    •Some of these include coronary artery disease, high blood pressure, heart valve problems, like mitral valve prolapse or a leaky aortic valve, and Long QT Syndrome.
    •Genetic conditions, like Marfan Syndrome and Ehlers Danlos Syndrome
    •A family history of preexcitation syndrome or other heart conditions is having an underlying heart defect—but this doesn't mean you'll definitely get it.
  • The most common cause of preexcitation syndrome is Wolff-Parkinson-White syndrome, which is present in about 50% of cases.
    •In this condition, there's an extra electrical pathway in your heart that allows some of the electrical impulses to travel from your atria to your ventricles (the chambers of your heart) before they're supposed to go through the AV node (the part of your heart that regulates how fast or slow each beat will be).
    •This means there's usually no problem with your heart rate or rhythm when you're at rest, but when you're exercising or doing other things that increase your heart rate, you may experience symptoms like dizziness or palpitations (an irregular heartbeat).
    •The risk factors for preexcitation syndrome are the same as the risk factors for atrial fibrillation, which is often a precursor to preexcitation syndrome.
    •Some of these include coronary artery disease, high blood pressure, heart valve problems, like mitral valve prolapse or a leaky aortic valve, and Long QT Syndrome.
    •Genetic conditions, like Marfan Syndrome and Ehlers Danlos Syndrome
    •A family history of preexcitation syndrome or other heart conditions
Symptoms
Fast heartbeat,Irregular or skipped heartbeats (also called extrasystoles),Shortness of breath, especially when exercising or at rest,Chest pain (angina) when exercising or at rest,Heart palpitations (irregular heartbeat that can feel like fluttering, pounding, or racing),Lightheadedness and fainting
Conditions
SVT,Ventricular preexcitation
Drugs
Beta blockers such as metoprolol (Lopressor, Toprol-XL),Propranolol (Inderal, Innopran XL),Atenolol (Tenormin)Aspirin,Ibuprofen

Is there a cure/medications for preexcitation syndrome?

At present, there are no medications approved by the FDA to treat preexcitation syndrome - PES. However, doctors may prescribe certain medications to help manage symptoms and prevent complications.

  • The medications include anti-arrhythmic drugs such as flecainide (Tambocor) and amiodarone (Cordarone).
  • The first thing to do is avoid stress. Stress can increase your risk of developing heart problems, so it's important to try and avoid it as much as possible. If you're feeling stressed out, try taking a walk outside or meditating for 10 minutes every day.
  • Another tip is to get plenty of sleep. Sleep deprivation has been linked to high blood pressure, which can increase the risk of preexcitation syndrome.
  • If you're having trouble sleeping at night because of symptoms like palpitations or tachycardia, try using some relaxation techniques before bedtime or setting an alarm so that you know when it's time to go to sleep.
  • You should also try eating healthy foods and exercising regularly—both are shown to reduce the risk of preexcitation syndrome in women with PCOS (polycystic ovary syndrome).
Symptoms
Fast heartbeat,Irregular or skipped heartbeats (also called extrasystoles),Shortness of breath, especially when exercising or at rest,Chest pain (angina) when exercising or at rest,Heart palpitations (irregular heartbeat that can feel like fluttering, pounding, or racing),Lightheadedness and fainting
Conditions
SVT,Ventricular preexcitation
Drugs
Beta blockers such as metoprolol (Lopressor, Toprol-XL),Propranolol (Inderal, Innopran XL),Atenolol (Tenormin)Aspirin,Ibuprofen

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