Abnormal EKG During HPSP Physical

[mrd5003]

So I had my Army HPSP physical the other day, and the results were marked sinus bradycardia (expected because I do a lot of cardio) and "WPW pattern Type A." The coordinator of my exam told me I would have to go talk to my primary care doctor and possibly a cardiologist for confirmation. Not knowing what "WPW pattern Type A" means, I looked it up on the internet when I returned home. It's called Wolff-Parkinson-White syndrome, a usually benign, rarely fatal abnormality in the pathway of conduction of electricity through the heart. The symptoms were definitely something I have experienced in the past while exercising without ever having been diagnosed with the syndrome. WPW is also one of the medical disqualifiers for service.

If I am diagnosed with WPW after talking to my PC doctor and maybe a cardiologist, is there any way I can still get the scholarship? Can I somehow waive that requirement because the syndrome has never turned into a life-threatening problem when it has manifested itself?

Thanks for your input.

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[Founder]

Have you talked to the military docs who did your physical? They should be able to advise you about possible waivers. I had a heart murmur and the flight surgeon who was reviewing my physical told me I could get a waiver.

 

[BOHICA-FIGMO]

WPW is also one of the medical disqualifiers for service.

If I am diagnosed with WPW after talking to my PC doctor and maybe a cardiologist, is there any way I can still get the scholarship? Can I somehow waive that requirement because the syndrome has never turned into a life-threatening problem when it has manifested itself?

Thanks for your input.

I have WPW and was able to get a waiver to fly (Class II flight physical) when I was in the USAF. Albeit, I had to do a Holter 24hr continuous EKG, doppler echocardiogram, and thallium stress test cry. Since I was active duty at the time, the military paid for everything. I don't know what the policy is for the Army or for new ascessions, but I would think a waiver would be possible. Good luck!

 

[mrd5003]

Thanks to both of you for your input. In the past, I've done a stress test (w/o thallium) and worn a Holter monitor for 24 hours as per a cardiologist's recommendations yet no diagnosis could be determined after both tests. During both tests, I was not able to make my heart go into the characteristic palpitations, which I'm sure would have been a dead giveaway on an EKG to the doctor.

 

[tulane06]

Thanks to both of you for your input. In the past, I've done a stress test (w/o thallium) and worn a Holter monitor for 24 hours as per a cardiologist's recommendations yet no diagnosis could be determined after both tests. During both tests, I was not able to make my heart go into the characteristic palpitations, which I'm sure would have been a dead giveaway on an EKG to the doctor.

Text deleted just in case it could be misconstrued as medical advise.

 

[iatrosB]

They didn't do an EKG at my MEPS...curious.

 

[The White Coat Investor]

I don't do waivers, but I'd expect that to be waiverable for a doc. Just carry some adenosine around in your pocket like an epi-pen

 

[Founder]

With cost, from what I understand as long as you go to a military facility they will cover the cost.

I was in ROTC on scholarship so I don't know if that is different for you mrd since you are not in ROTC?

But they paid for it because the flight doc ordered it. When I raised the issue of cost they said I could get it done at a military facility or at a civilian one. So I just took an early weekend from school and go an echo.

 

[kingcer0x]

I don't do waivers, but I'd expect that to be waiverable for a doc. Just carry some adenosine around in your pocket like an epi-pen

isn't adenosine improper for rapid ventricular rate in a patient with WPW? unless it is true narrow complex tachycardia that he's having and he needs to be cardioverted. off topic, but...

 

[The White Coat Investor]

isn't adenosine improper for rapid ventricular rate in a patient with WPW? unless it is true narrow complex tachycardia that he's having and he needs to be cardioverted. off topic, but...

http://www.acls.net/acls2005/tach.htm

Per emedicine, orthodromic tachycardias (narrow because the impulse goes through the AV node) are 10-15X more likely than antidromic tachycardias (wide because the impulse goes down the accessory pathway to the ventricle). PSVT and orthodromic tachycardia secondary to WPW can be difficult to differentiate in the tachycardic patient. Luckily, adenosine is fine for treating both of them and works (so far in my short career) 100% of the time, although I have at times had to use a second dose.

Antidromic tachycardia can be difficult to differentiate from V-tach. It typically will also disappear if treated with adenosine, however, you're probably better off treating it as V-tach lest you convert v-tach to v-fib using adenosine after mistaking the rhythm for a supraventricular tachycardia.

Thus the ACLS pathway: Stable? Narrow? Regular? If yes to all then vagal maneuvers, adenosine, then dilt.

The tricky rhythm associated with WPW is a-fib. This can be irregular and wide. You DO NOT want to treat this with standard a-fib treatment (beta-blockers, CCBs, dig etc) because that can make it go even faster through the accessory pathway. Procainamide is an option, but since they're usually unstable, cardioversion tends to become the treatment of choice.

Now maybe I'll go market adeno-pens. If only it worked IM.

http://www.emedicine.com/emerg/TOPIC644.HTM

 

[kingcer0x]

http://www.acls.net/acls2005/tach.htm

Per emedicine, orthodromic tachycardias (narrow because the impulse goes through the AV node) are 10-15X more likely than antidromic tachycardias (wide because the impulse goes down the accessory pathway to the ventricle). PSVT and orthodromic tachycardia secondary to WPW can be difficult to differentiate in the tachycardic patient. Luckily, adenosine is fine for treating both of them and works (so far in my short career) 100% of the time, although I have at times had to use a second dose.

Antidromic tachycardia can be difficult to differentiate from V-tach. It typically will also disappear if treated with adenosine, however, you're probably better off treating it as V-tach lest you convert v-tach to v-fib using adenosine after mistaking the rhythm for a supraventricular tachycardia.

Thus the ACLS pathway: Stable? Narrow? Regular? If yes to all then vagal maneuvers, adenosine, then dilt.

The tricky rhythm associated with WPW is a-fib. This can be irregular and wide. You DO NOT want to treat this with standard a-fib treatment (beta-blockers, CCBs, dig etc) because that can make it go even faster through the accessory pathway. Procainamide is an option, but since they're usually unstable, cardioversion tends to become the treatment of choice.

Now maybe I'll go market adeno-pens. If only it worked IM.

http://www.emedicine.com/emerg/TOPIC644.HTM

Cool, thanks!!!