Wolff-Parkinson-White syndrome is treatable

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DEAR DR. DONOHUE: I am 35, a high-school football coach and a history teacher. I played football in high school and college, and have been active in athletics all my life. Last week, I had my first EKG. The doctor said I had Wolff-Parkinson-White syndrome and that I might need an “intervention” in the future.

What is this intervention? Is this a heart condition that puts an end to my coaching? Why wasn’t it discovered before? I have had many physical exams. – R.D.

ANSWER:
In a normal heart, the electric signal generated by the heart’s pacemaker travels to the right and left ventricles on two freeways called the right and left bundles. When the signal reaches the ventricles – the heart’s lower chambers – they contract to pump blood out of the heart.

Your heart has three freeways – the right and left bundles, plus an extra route called an accessory pathway. If the electric signal coming from the pacemaker takes that third route, your heartbeat suddenly speeds up. That’s Wolff-Parkinson-White syndrome, or WPW.

Apparently your heart has never sped up. That’s one reason your WPW wasn’t diagnosed before. Moreover, you just had your first EKG; WPW is diagnosed with an EKG.

Since you’ve never had episodes where your heart suddenly started racing, you don’t need treatment. If you begin to have such episodes, medicines can often stop a speeding heart.

The ultimate solution to WPW that produces symptoms is to destroy the extra pathway; this is the intervention your doctor mentioned. It can be done with a catheter threaded to your heart from a blood vessel in the groin.

It’s not a procedure that keeps you on your back for any length of time – and you might never face the prospect of having it done. WPW should not put an end to your coaching career or your sporting life. If you reach 50 without any heart speed-ups, you’re not likely to experience one.

DEAR DR. DONOHUE: I have had, on at least five occasions, chest pains that made me think I was having a heart attack. All my tests have been normal, including a stress test. A heart doctor decided to catheterize me, and he discovered I was having heart artery spasms, which caused the pain. I carry nitroglycerin with me. Could I still have a heart attack? – T.D.

ANSWER:
You have an unusual kind of angina – chest pain that comes about when heart muscle doesn’t get enough blood. Your angina goes by the name of Prinzmetal’s angina or variant angina. Regular angina arises when a person is active, bustling around. Prinzmetal’s angina occurs when people are at rest, just sitting.

In your angina, heart muscle is deprived of blood due to a sudden constriction of a heart artery. That kinks the artery, so blood flow to the heart temporarily stops. Pain arises during the phase of artery constriction and goes away when the artery dilates. Prinzmetal’s angina is often hard to confirm. During an episode of chest pain, an EKG shows changes typical of the condition, but most people don’t have the good fortune of having an EKG running while they’re having chest pain. To prove the diagnosis, a heart doctor often must catheterize the heart arteries. A catheter is a pliable tube that is threaded into the heart arteries from an artery in the groin.

If Prinzmetal’s angina is suspected, the doctor gives the patient a drug called ergonovine, which causes the artery to constrict, something that doesn’t happen to normal arteries.The most dangerous time for a person with Prinzmetal’s angina is the first six months of symptoms. After six months, the frequency of chest pains starts to diminish. The survival rate for Prinzmetal’s patients is high – 95 percent at the five-year mark. The threat of a heart attack is not great.

Nitrate drugs, like nitroglycerin, are standard treatment. So are drugs called calcium channel blockers. Some brand names are Cardizem, Procardia, Cardene, Plendil and Norvasc. The booklet on coronary (heart) artery disease discusses ordinary angina. Readers can order a copy by writing: Dr. Donohue – No. 101, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com

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