Hypertrophic Cardiomyopathy and Wolff-Parkinson-White Syndrome in a Young African Soldier with Recurrent Syncope

Abstract

Syncope is a common manifestation of both hypertrophic cardiomyopathy (HCM) and Wolff-Parkinson-White (WPW) syndrome. The most common arrhythmia in HCM is ventricular tachycardia (VT) and atrial fibrillation (AF). While preexcitation provides the substrate for reentry and supraventricular tachycardia (SVT), AF is more common in patients with preexcitation than the general population. Concurrence of HCM and WPW has been reported in many cases, but whether the prognosis or severity of arrhythmia is different compared to the individual disorders remains unsettled. We report a case of HCM and Wolff-Parkinson-White (WPW) syndrome in a 28-year-old male Nigerian soldier presenting with recurrent syncope and lichen planus.

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“…Of the predicted P/LP variants on the ACMG SFv3.0, a pathogenic variant of PRKAG2 was identified in two individuals. Variants in PRKAG2 are associated with the autosomal dominantly inherited Wolff Parkinson White Pattern(WPWP) (Chhabraetal.,2023).WPWPisacongenitalanomalyaffectingthenormalconductionoftheelectricalimpulsesbetweentheatriaandventricles.Commonly associatedsymptomsincludechestpain,palpitations,progressive shortness of breath, syncope and, in rare cases, suddencardiacdeath (Talleetal., 2019).Theinformation on the epidemiology of WPW has been limited in sub-SaharanAfricabyinadequateresources,diagnosticequipment and screening programs (Ogunlade & Asafa, 2017;Talle et al, 2019). A prevalence of 0.11% in Nigeria was reportedinacohortofyoungadultsaged15-40 (Ogunlade & Asafa, 2017).…”

“…WPWP is a congenital anomaly affecting the normal conduction of the electrical impulses between the atria and ventricles. Commonly associated symptoms include chest pain, palpitations, progressive shortness of breath, syncope and, in rare cases, sudden cardiac death (Talle et al, 2019 ). The information on the epidemiology of WPW has been limited in sub‐Saharan Africa by inadequate resources, diagnostic equipment and screening programs (Ogunlade & Asafa, 2017 ; Talle et al, 2019 ).…”

“…Commonly associated symptoms include chest pain, palpitations, progressive shortness of breath, syncope and, in rare cases, sudden cardiac death (Talle et al, 2019 ). The information on the epidemiology of WPW has been limited in sub‐Saharan Africa by inadequate resources, diagnostic equipment and screening programs (Ogunlade & Asafa, 2017 ; Talle et al, 2019 ). A prevalence of 0.11% in Nigeria was reported in a cohort of young adults aged 15–40 (Ogunlade & Asafa, 2017 ).…”

“…A prevalence of 0.11% in Nigeria was reported in a cohort of young adults aged 15–40 (Ogunlade & Asafa, 2017 ). Another case report by Talle et al provided information from a patient who was diagnosed with WPW IN Nigeria, whose evaluation and management were hindered by a lack of facilities and the required expertise (Talle et al, 2019 ); furthermore, the authors stress that the availability of diagnostic options such as ambulatory ECG, cardiac magnetic resonance imaging (MRI), electrophysiological study (EP study) and genetic testing would have allowed for better management (Talle et al, 2019 ). Overall, early risk assessment may result in no intervention in asymptomatic individuals, preventive antiarrhythmic medications, to prophylactic accessory pathway ablation based on the level of risk (Chhabra et al, 2023 ).…”