# Masked ECG Changes in Wolff-Parkinson-White Syndrome Coexisting With Myocardial Infarction: A Case Report

## TL;DR

A case report shows how Wolff-Parkinson-White syndrome can mask heart attack symptoms, emphasizing the need for troponin tests and echocardiography for accurate diagnosis.

## Contribution

Highlights the diagnostic challenges of myocardial infarction in patients with Wolff-Parkinson-White syndrome and the importance of early troponin and echocardiography use.

## Key findings

- WPW syndrome can obscure typical ECG signs of myocardial infarction.
- High-sensitivity troponin levels and echocardiography are critical for early diagnosis in such cases.
- Coronary angiography showed vessel ectasia and slow flow without obstruction.

## Abstract

Wolff-Parkinson-White (WPW) syndrome, known for episodes of tachycardia and distinctive electrocardiographic (ECG) patterns, often makes it harder to diagnose myocardial infarction (MI) because it can hide the usual ECG signs of MI. Early use of high-sensitivity troponin levels and echocardiography to detect myocardial injury in WPW is important, facilitates timely intervention and improves patient outcomes. This report presents the case of a 39-year-old Caucasian male with no chronic disease history who presented to a family health center with intermittent mild chest pain localized to the left side, characterized by a burning and dull ache, for one week. On the day of presentation, the patient experienced increased pain accompanied by palpitations and mild sweating. An ECG at the family health center showed findings of WPW. Due to the presence of typical chest pain and WPW pattern on the ECG, the patient was referred to a tertiary hospital emergency department. At the tertiary hospital, repeat ECGs showed no changes, but blood tests revealed elevated troponin T levels (495 ng/ml initially, 485 ng/ml after 4 hours). The patient was admitted to the cardiology critical care ward. Echocardiography indicated regional wall motion abnormalities in specific segments. Coronary angiography revealed ectasia in vessels with slow flow but no obstructed vessels. This case underscores the diagnostic challenges posed by WPW syndrome in the context of MI and highlights the importance of using high-sensitivity troponin levels and echocardiography for early diagnosis to improve patient outcomes.