Dr Ari Rafael (Cale) and John Lentink work as detectives
In Dr Rafael’s treatment room the 51-year old stated what he had said to so many doctors already: “Sometimes out of the blue my heart starts to race and I then feel very weak und restless!” But until now no one has been able to find the diagnosis. Our American GP and our ultrasound specialist John Lentink had a suspicion of what the problem was and they wanted to prove it.
They suspected that the patient was suffering from an excitation syndrome, its most common form is called “Wolff-Parkinson-White”, a disorder due to the patient having an additional accessory electrical conduction pathway between the atria and the ventricles, which a healthy heart does not have. Thereby circular electrical stimulations occur, which can result in sudden heart palpitations.
Our two colleagues performed a 24 hour electrocardiogram followed by a stress-ECG. The patient had hardly started cycling on the bicycle when the attack started. His heartbeat increased to 220/minute.
Immediately he was transferred to the intensive care unit and was treated with the medication Adenosine (Antiarrhythmicum). And lo and behold his pulse jumped back into the normal sinus rhythm.
The exact evaluation of the results points in the case of this patient to an additional accessory electrical conduction pathway in the region of the AV-node. We appear to have an AV nodal re-entrant tachycardia. Roughly 0.1-0.3% of humans suffer from these conduction system problems. A lasting therapy entails a stop of the electrical flow by means of a catheter procedure.
Ari and John’s excellent work make them two very eligible candidates for the Diospi-Suyana-Sherlock-Holmes-Prize 2017.