Wolff-Parkinson-White Syndrome is characterised by all of the following, EXCEPT:

Appeared in: DSSSB 14 August 2024

Explanation

Salvador Dali sagging is the correct answer because it is the feature not associated with Wolff-Parkinson-White (WPW) Syndrome.
This specific ECG finding, a scooped ST-segment depression, is a hallmark sign of Digoxin effect or toxicity.
WPW syndrome is a pre-excitation disorder with its own distinct triad of ECG findings: a short PR interval, a delta wave, and a wide QRS complex.
The other three options are the classic components of the WPW pattern on an ECG.

Option A: A wide QRS complex is a characteristic feature of WPW syndrome.
Option B: The delta wave is the hallmark ECG finding in WPW syndrome.
Option D: A short PR interval is a classic criterion for diagnosing WPW syndrome.

Clinical Relevance

Nursing practice connection: Knowing ECG characteristics of Wolff-Parkinson-White (WPW) Syndrome helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Recognizing the ECG patterns of WPW is critical for nurses as these patients are at risk for life-threatening tachyarrhythmias, such as atrial fibrillation with a rapid ventricular response, which can degenerate into ventricular fibrillation.
Nurses must monitor for symptoms like palpitations, dizziness, or syncope and be prepared for emergency interventions like vagal maneuvers or administration of antiarrhythmic drugs.
What if? If a patient with WPW syndrome develops atrial fibrillation, the use of AV nodal blocking agents (like adenosine, beta-blockers, calcium channel blockers, and digoxin) is contraindicated. These drugs can block the normal AV pathway, forcing all impulses down the fast accessory pathway, which can dangerously increase the ventricular rate and lead to ventricular fibrillation. Treatment would instead involve procainamide or electrical cardioversion.

How to Approach the Question

First, identify that this is an 'EXCEPT' question, meaning you must find the option that does not belong.
The core concept is the electrocardiogram (ECG) characteristics of Wolff-Parkinson-White (WPW) Syndrome.
Recall the classic triad of ECG findings for WPW: 1) Short PR interval, 2) Delta wave, and 3) Wide QRS complex.
Evaluate each option against this triad.
The option that is not part of the classic WPW triad is the correct answer.
Recognize 'Salvador Dali sagging' as a finding related to a different condition (Digoxin toxicity), making it the exception.

Concept Tested & Keywords

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E6 Physiology Ganong 27e Vol 2 Part 1 p. 80-82

E6 Medicine Harrison 22e Part 1 p. 1981-1983

Practise the full DSSSB 14 August 2024

Attempt every question from this paper in a timed mock, then review the full solution for each one.