Lown-Ganong-Levine syndrome: Difference between revisions
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==Background== | ==Background== | ||
*Poorly understood pre-excitation condition | *Poorly understood pre-excitation condition | ||
* | *[[Atrioventricular re-entrant tachycardia]] (AVRT) due to James fibers | ||
**Bundle of James accessory pathway creates atrio-hisian bypass tract | **Bundle of James accessory pathway creates atrio-hisian bypass tract | ||
***Convincing existence of the James accessory pathway has not been conclusively demonstrated | ***Convincing existence of the James accessory pathway has not been conclusively demonstrated | ||
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==Clinical Features== | ==Clinical Features== | ||
*[[Palpitations]] | *[[Palpitations]] | ||
*[[Paroxysmal supraventricular tachycardia]] | |||
*Short PR interval on ECG | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Tachycardia (narrow) DDX}} | |||
{{Palpitations DDX}} | {{Palpitations DDX}} | ||
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**Normal QRS | **Normal QRS | ||
**No delta wave | **No delta wave | ||
*May appear | **May have ventricular premature complexes | ||
*May appear similar to: | |||
**[[WPW]] | **[[WPW]] | ||
**AV junctional | **AV junctional rhythm | ||
==Management== | ==Management== | ||
*Vagal manoeuvres may terminate episodes of SVT | |||
*Counsel to avoid alcohol, coffee, and other stimulants | |||
*Patients with demonstrated accessory pathways on electrophysiological study may benefit from ablation | |||
==Disposition== | ==Disposition== | ||
*Home with cardiology follow up | |||
*Consider referral for Holter monitor, echo to rule out structural disease, and electrophysiologic studies | |||
==See Also== | ==See Also== | ||
Latest revision as of 11:55, 6 April 2019
Background
- Poorly understood pre-excitation condition
- Atrioventricular re-entrant tachycardia (AVRT) due to James fibers
- Bundle of James accessory pathway creates atrio-hisian bypass tract
- Convincing existence of the James accessory pathway has not been conclusively demonstrated
- Bundle of James accessory pathway creates atrio-hisian bypass tract
Clinical Features
- Palpitations
- Paroxysmal supraventricular tachycardia
- Short PR interval on ECG
Differential Diagnosis
Narrow-complex tachycardia
- Regular
- AV Node Independent
- Sinus tachycardia
- Atrial tachycardia (uni-focal or multi-focal)
- Atrial fibrillation
- Atrial flutter
- Idiopathic fascicular left ventricular tachycardia
- AV Node Dependent
- AV Node Independent
- Irregular
- Multifocal atrial tachycardia (MAT)
- Sinus tachycardia with frequent PACs, PJCs, PVCs
- Atrial fibrillation
- Atrial flutter with variable conduction
- Digoxin Toxicity
Palpitations
- Arrhythmias:
- Non-arrhythmic cardiac causes:
- Psychiatric causes:
- Drugs and Medications:
- Alcohol
- Caffeine
- Drugs of abuse (e.g. cocaine)
- Medications (e.g. digoxin, theophylline)
- Tobacco
- Misc
Evaluation
- ECG
- Short PR interval
- Normal QRS
- No delta wave
- May have ventricular premature complexes
- May appear similar to:
- WPW
- AV junctional rhythm
Management
- Vagal manoeuvres may terminate episodes of SVT
- Counsel to avoid alcohol, coffee, and other stimulants
- Patients with demonstrated accessory pathways on electrophysiological study may benefit from ablation
Disposition
- Home with cardiology follow up
- Consider referral for Holter monitor, echo to rule out structural disease, and electrophysiologic studies