TYPE A PRE-EXCITATION PATTERN INITIALLY DIAGNOSED AS ANXIETY: THE IMPORTANCE OF ECG IN PRIMARY CARE.
Authors
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Luis Fernando Toscano Dulcey
Fundación Cardiovascular, Bucaramanga, Colombia.
https://orcid.org/0009-0003-7656-1904
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Luis Andres Dulcey Sarmiento
Universidad de Mérida, Bucaramanga, Colombia.
https://orcid.org/0000-0001-9306-0413
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Jorge Andrés Hernández Navas
Universidad de Santander. Bucaramanga, Colombia.
https://orcid.org/0009-0001-5758-5965
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Abstract
The pattern of pre-excitation associated with an accessory pathway is a relevant cause of palpitations and tachyarrhythmias in young adults, especially when it is not recognized promptly at the primary care level. The objective of this report is to describe the clinical presentation, the diagnostic process, and the evolution of a patient with an electrocardiographic pattern compatible with Type A pre-excitation, initially interpreted as an anxiety disorder. A review of the patient's clinical history, physical examination, and complementary studies was performed. We present the case of a 29-year-old man with intermittent episodes of sudden-onset palpitations, lasting from seconds to minutes, occasionally accompanied by dyspnea and a sensation of distress. In a previous evaluation, he had been categorized as having an anxiety disorder without complete criteria. The resting electrocardiogram showed a short PR interval, initial QRS slurring (delta wave), and secondary repolarization abnormalities, findings suggestive of a Type A pre-excitation pattern. The patient was referred to electrophysiology, where a left-sided accessory pathway was confirmed, and successful ablation was performed, leading to complete resolution of symptoms. This case highlights the importance of systematic electrocardiogram interpretation in primary care and reinforces the need to consider cardiological causes in young patients with palpitations before concluding a psychiatric diagnosis.
Keywords:
Wolff-Parkinson-White syndrome , cardiac arrhythmia , electrocardiography , primary health care , anxiety disordersReferences
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