WHAT IS WPW?

     Stories make wonderful teaching tools.  Everyone loves a story and if it carries a message that a person can apply to another area of their life it frequently will be well remembered.

     This is the story of a lady who was not very trusting.  She came to the office many years ago after she had briefly lost the function in her right arm and her ability to speak.  She had what is called a “transient ischemic attack” in which the blood supply to a part of her brain had been blocked off for a brief period of time but then fortunately re-established.  In her case, it was due to a tiny blood clot that lodged in the blood vessel supplying a certain part of her brain.  That blood clot fortunately broke up and melted enough that the brain was not permanently damaged.  But for a period of about three days, she had little function on her right arm and was unable to speak normally.  The doctor who was caring for her then told her that she had WPW syndrome and suggested that she needed to be treated with blood thinners.  She had heard all kinds of stories about the dangers of blood thinners and didn’t buy the idea at all.  She came to me wondering what she should do and asking what was the WPW syndrome.

     I started by telling her that WPW were letters used to designate the “Wolff-Parkinson-White” syndrome.  These were three doctors who originally recognized the nature of the problem she had and their name got applied to this particular disease problem.  She asked what the word “syndrome” meant.  I explained that a syndrome is a group of findings that give a doctor the ability to recognize a situation.  As an example of a syndrome, I laughed at a young mother who recently told me that her brother didn’t recognize “the baby-poop syndrome”.  She said that her 19 year old brother had been taking care of the baby for a few hours while she went out.  She says that when she got home her brother told her that the baby briefly became restless and then got red in the face and seemed to be straining.  The baby then seemed to relax and fall asleep. He had noticed that there was now a foul odor in the room and hoped that everything was OK.  The young mother said that her brother simply didn’t recognize the “baby-poop syndrome”. Thus a syndrome can be thought of as a group of findings that allows a person to draw a conclusion about what has happened.

     But to return to the WPW syndrome, I told her that this was a group of findings that happen in people with a certain kind of heart problem.  These patients have repeated episodes where their heart would pound very fast.  Associated with this, they could become weak.  Many times patients with this problem faint and there is an inordinately high likelihood that young individuals who died suddenly in their teens or 20’s had this problem.  It was also noted that patients with this syndrome had a finding called a “delta wave” on their electrocardiogram.  By examining the hearts of these young individuals who had died, Dr.s Wolff, Parkinson and White noticed that there where abnormal pieces of muscle on the inside of the heart that allowed the heart to beat too fast.  People with this problem may have their heart beat more than 200 times a minute.  When a heart beats that fast, it doesn’t have time to fill up with blood and the heart beats are ineffective.  Without any blood to pump from the heart, the person’s brain doesn’t get enough blood and they pass out.

     So I told her that the Wolff-Parkinson-White syndrome was a name applied to a group of findings where relatively young people have recurrent episodes of very fast heart beats, an abnormal electrocardiogram and that some of these individuals die suddenly and unexpectedly at a young age.  The rest of the syndrome was that these individuals had an abnormal piece of muscle on the inside of their heart.  That was the syndrome.  A doctor can be aware that a young person is at significant risk of premature sudden death by recognizing this syndrome.

     The lady now said that she was just about scared to death.  What should she do?  I told her that sometimes people with WPW syndrome do get blood clots and have strokes such as she had.  I said that this was unusual but tend to recur in people that have had the problem at least once.  I told her that blood thinners were probably a good idea for her and that the benefits outweighed the risks.

     I asked if her previous physician had talked to her about the cure for Wolff-Parkinson-White syndrome.  This is one of the few heart conditions that can be totally permanently cured.  She said that he had mentioned something about an “ablation” but she didn’t know what that meant and was too embarrassed to ask.  I explained to her that there is a method whereby the abnormal piece of muscle on the inside of the heart can be gotten rid of and then the whole problem of the Wolff-Parkinson-White syndrome is permanently gone.  She liked the ring of “permanently gone” but wondered what an ablation was.

     I explained that there is a way for very specially trained heart doctors to pass a wire up to the heart and find this abnormal piece of muscle without ever cutting the person open.  Once the abnormal piece of heart muscle can be found, it can be gotten rid of through the use of radiofrequency waves.  This is real “Star Wars” very high technology stuff but it works remarkably well, is much safer than leaving the Wolff-Parkinson-White syndrome in place and an ablation permanently cures the problem.

     As I said, this lady was very untrusting.  It was almost as though she spaced out not hearing what she was being told.  She said it was too scary to think about.  I told her the scary part was to let it go, not get blood thinners, and not get the ablation done.  She said she wanted to think about it.

     I never saw her again.  She just wanted a second opinion, and I don’t know what she ever did with the information she got.  I have had other patients with this same kind of problem who did believe, did go get the ablation done and now are cured.  That is one of the real fun things about the practice of medicine.  It is a very special thrill when a potentially fatal condition can be diagnosed and effectively treated leaving the person with many years of useful life.  I will always wonder what happened to the lady who started this story.