Doc: Signal to heart can be blocked
Dear Dr. Roach: I recently was diagnosed with Wolff-Parkinson-White syndrome. I have seen two cardiologists, and while I feel they have done what they think is right, I believe that because we have had a sudden cardiac death in our family, more monitoring should be done. I have had a stress test, a monitor that I wore for 24 hours and an ultrasound. The ultrasound showed a healthy heart, and the monitor showed signs of a high heart rate, but apparently there were no corresponding symptoms at that particular time. I have told them I have minor (now that I am used to them) chest pains every day, with rapid heartbeat that radiates to my back, dizziness, nausea, etc. They have told me that my pathway is not activated right now and that when it becomes activated, I most likely will pass out and have worse chest pain. I had an episode the other day where I stood up from a chair and couldn’t breathe, and had chest pain radiating to my back. It took about five minutes to go away. I was not doing anything strenuous at the time.
Dear J.P.: The Wolff-Parkinson-White pattern is a finding on an electrocardiogram of an “accessory pathway” — a way for the electrical impulse to bypass the usual path at the AV node, the junction of the atria and the ventricles, where the impulse slows down to allow the blood to flow optimally. It is not rare — perhaps one person in 400 will have this finding on an EKG — but only about 1 percent of people with the EKG abnormality will develop symptoms (according to a 22-year-long study). People with symptoms and WPW pattern are said to have WPW syndrome. The likelihood of sudden cardiac death is low in this group; however, with a family member having a history of sudden cardiac death, an evaluation such as what you had is called for.
The optimal management of WPW isn’t completely clear. Most people probably do not need intervention. However, persistent symptoms should make your cardiologist consider an electrophysiologic study and a catheter ablation, which uses radio waves to block the accessory pathway. I am surprised you haven’t been offered this, and I suggest you see an electrophysiologist, a cardiologist with additional training in diagnosing and treating electrical problems of the heart. Please let me know what happens.
Dr. Roach Writes: A recent column on trigeminal neuralgia attracted a lot of attention among the community of people and their families affected by this disorder. Many people helped me learn things that I didn’t know about this disorder, including the fact that perhaps 25 percent of respondents in one online group describe atypical symptoms of constant, 24/7 burning, aching, throbbing pain, which is different from the classic intermittent electric-shock sensations that I wrote about in my original column. These symptoms often occur in addition to volleys of the classic electric-shock sensations. Although the mean age when pain began is 43, I read stories of young children with this condition.
Many cases of TN are caused by compression of the nerve root by a blood vessel. Although surgical treatment to decompress the nerve root, radiation, thermal ablation, glycerol or balloon compression is effective for many with the typical form of TN, the relief provided by these procedures can be only temporary. Microvascular nerve decompression is effective in about 90 percent of people with classic symptoms, and the relief lasts over seven years for 70 percent, and over 12 years for about half. People with atypical symptoms don’t do as well.
Unfortunately, it doesn’t work for everyone. You can read some powerful stories on my Facebook page at facebook.com/keithroachmd. You also can find out more or donate at livingwithtn.org, fpasupport.org and tnnme.com.
Email questions to ToYourGoodHealth@med.cornell.edu.