Profound exercise-induce ST segment depression in a patient with Wolff-Parkinson-White syndrome and normal coronary arteriograms.

The electrocardiogram is notoriously unreliable for the diagnosis of ischaemic heart disease in patients with Wolff-Parkinson-White syndrome. Abnormalities in the resting tracing may lead to false positive diagnoses of inferior or anterior myocardial infarction. Although ST segment depression with exercise has been reported in patients with Wolff-Parkinson-White syndrome, the depth of depression has been modest (2 mm or less).' In the present report we describe marked ST segment depression (>4 mm) during exercise in a patient with Wolff-Parkinson-White syndrome who was shown subsequently to have normal coronary anatomy by arteriography and normal myocardial function by resting and exercise radionuclide angiography.