The Diagnosis of Myocardial Infarction in the Wolff-Parkinson-White Syndrome

¹ Trainee in Cardiology, University of Rochester
² Associate Professor of Medicine, University of Rochester
³ Chief of Cardiology, The Genesee Hospital and Associate Professor of Medicine, University of Rochester

This review describes the various aspects of the diagnosis of myocardial infarction coexisting with the Wolff-Parkinson-White syndrome. In this situation, the diagnosis of myocardial infarction is frequently difficult because the delta wave may obliterate the Q wave of infarction or may itself simulate infarction. ST-T wave abnormalities are notoriously unreliable in the evaluation of myocardial ischemia or infarction during preexcitation, although serial electrocardiograms showing evolution of primary changes occasionally provide important clues. The diagnosis of myocardial infarction becomes simple when normal conduction resumes and thus an attempt, including the use of drugs, should be made to abolish preexcitation. During preexcitation, left ventricular extrasystoles may unmask an infarcted area by restoring the initial negativity of the left ventricular cavity. The recognition of bundle branch or fascicular block in suspected myocardial infarction complicated by preexcitation is of more than academic interest since the anomalous bundle cannot be depended on to provide reliable A-V conduction should high grade A-V block develop in the normal pathway. Exercise stress testing has generally been considered unreliable in the evaluation of patients with Wolff-Parkinson-White syndrome.

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