Other known aliases – atrioventricular bypass tract
Definition – As discussed in the WPW eponym, the Bundle of Kent is an accessory conduction pathway between the atrium and ventricle on either the right or left side of the heart.
Clinical Significance – this pathway occurs in up to 0.3% of patients and the cause of Wolff-Parkinson-White syndrome. It bypasses the traditional conduction system and allows for pre-excitation tachydysrthymias.
History – Named after Albert Frank Stanley Kent (1863-1958), an English physiologist who received his degree in 1886 from the Magdalen College of Oxford. He first described lateral atrioventricular connections in a monkey heart in 1893 and erroneously believed these were part of the normal specialized conduction system. These findings generated a lot of controversy at the time and were actually rejected by several notable anatomists and physiologists. In fact, in 1955, Lev and Learner dissected 33 neonatal hearts and found no evidence of “normal” lateral conduction systems.
References
Firkin BG and Whitwirth JA. Dictionary of Medical Eponyms. 2nd ed. New York, NY; Parthenon Publishing Group. 1996.
Bartolucci S, Forbis P. Stedman’s Medical Eponyms. 2nd ed. Baltimore, MD; LWW. 2005.
Yee AJ, Pfiffner P. (2012). Medical Eponyms (Version 1.4.2) [Mobile Application Software]. Retrieved http://itunes.apple.com.
Kent AF. Researches on the Structure and Function of the Mammalian Heart. The Journal of physiology. 1893; 14(4-5):i2-254. [pubmed]
LEV M, LERNER R. The theory of Kent; a histologic study of the normal atrioventricular communications of the human heart. Circulation. 1955; 12(2):176-84. [pubmed]
Other known aliases – ventricular pre-excitation with arrhythmia, auriculoventricular accessory pathway syndrome
Definition – paroxysmal supraventricular tachycardia caused by conduction through an abnormal accessory bypass tract between the atria and ventricles known as the Bundle of Kent. There are two types depending on the side of the heart it effects; Type A is between the right atrium and ventricle and Type B is between the left atrium and ventricle.
Clinical Significance – Patients with WPW can numerous cardiac dysfunction symptoms including tachydysrhythmias, palpitations, dyspnea, presyncope, syncope, and sudden cardiac arrest. It is characterized by the triad of abnormalities on EKG of widened QRS, shortened PR interval, and slurring of the initial part of the QRS (called a delta wave).
History – Named after Louis Wolff (1898-1972), Sir John Parkinson (1885-1976), and Paul Dudley White (1886-1973). Dr. Wolff was an American cardiologist who received his medical doctorate from Harvard Medical School in 1922. Dr. Parkinson was an English cardiologist who received his medical doctorate from University of Freiburg in 1910 and was also knighted by King George in 1948. Dr. White was an American cardiologist who received his medical doctorate from Harvard Medical School in 1911 and one of the founding presidents for the American Heart Association. He was a prominent advocate for preventive medicine receiving many national and international awards for his efforts to advance the importance of diet, exercise, and weight control in the prevention of cardiovascular disease. They collaborated to publish a series of 11 cases entitled “Bundle‐Branch Block with Short P‐R Interval in Healthy Young People Prone to Paroxysmal Tachycardia” in the American Heart Journal in 1930. It should be noted that Dr. Frank Norman Wilson and Dr. Alfred Wedd both described and published these findings in 1915 and 1921.
Wolff
Parkinson
White
References
Firkin BG and Whitwirth JA. Dictionary of Medical Eponyms. 2nd ed. New York, NY; Parthenon Publishing Group. 1996.
Bartolucci S, Forbis P. Stedman’s Medical Eponyms. 2nd ed. Baltimore, MD; LWW. 2005.
Yee AJ, Pfiffner P. (2012). Medical Eponyms (Version 1.4.2) [Mobile Application Software]. Retrieved http://itunes.apple.com.
Wolff L, Parkinson J, White PD. Bundle‐Branch Block with Short P‐R Interval in Healthy Young People Prone to Paroxysmal Tachycardia. American Heart Journal. 1930;5(6):985-704 [article]
You have a patient in the ED with an aortic dissection and are managing them while awaiting the cardiovascular surgeon to arrive.
What are the two most important things to control?
How do you go about doing that?
Answer
The main aims of acute medical management of aortic dissections are to decrease the rate of left ventricular contraction and decrease the velocity of the contraction, which will overall decrease the shear stress at the site of the tear and slow progression.
Start with intravenous beta-blockade and titrate to a heart rate of 60 betas/minute
If systolic blood pressure is > 120 mmHg after successful beta-blockade, then add a vasodilator or afterload reducer.
Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010; 121(13):e266-369. [pubmed]
Tsai TT, Nienaber CA, Eagle KA. Acute aortic syndromes. Circulation. 2005; 112(24):3802-13. [pubmed]
Other Known Aliases – diagnostic criteria for acute rheumatic fever
Definition – clinical criteria to help diagnose acute rheumatic fever. There are divided into major and minor criteria as follows:
Major
Polyarthritis
Carditis
Subcutaneous nodules
Erythema marginatum
Sydenham’s chorea
Minor
Fever
Arthralgia
Elevated ESR or CRP
Leukocytosis
1st degree heart block
Clinical Significance – a diagnosis of acute rheumatic fever is either two major or one major and two minor criteria
History –Named after T. Duckett Jones (1899-1954), an American cardiologist who received his medical doctorate from the University of Virginia in 1923. With a keen interest in rheumatic fever and heart disease, he practiced at Massachusetts General Hospital and House of Good Samaritan in Boston for over 20 years. He became the medical director of the Helen Way Whitney Foundation to pursue his passion for public health, which led to one of the first tweleve appointments to the National Advisory Heart Council in 1948. He published his seminal paper entitled “The Diagnosis of Rheumatic Fever” in JAMA in 1944 which described these findings. Dr. Jones unfortunately died as a result of malignant hypertension in 1954 at the age of 55.
References
Firkin BG and Whitwirth JA. Dictionary of Medical Eponyms. 2nd ed. New York, NY; Parthenon Publishing Group. 1996.
Bartolucci S, Forbis P. Stedman’s Medical Eponyms. 2nd ed. Baltimore, MD; LWW. 2005.
Yee AJ, Pfiffner P. (2012). Medical Eponyms (Version 1.4.2) [Mobile Application Software]. Retrieved http://itunes.apple.com.
