|
|
| Line 19: |
Line 19: |
| '''''Synonyms and key words:''''' Morgagni-Adams-Stokes syndrome or Stokes-Adams Attack | | '''''Synonyms and key words:''''' Morgagni-Adams-Stokes syndrome or Stokes-Adams Attack |
|
| |
|
| == Overview ==
| |
|
| |
| This refers to a sudden, transient episode of [[syncope]], occasionally featuring [[seizure]]s. It is named after two Irish physicians,<ref>{{WhoNamedIt|synd|1158}}</ref> [[Robert Adams (physician)|Robert Adams]] (1791–1875)<ref>R. Adams. Cases of Diseases of the Heart, Accompanied with Pathological Observations. Dublin Hospital Reports, 1827, 4: 353-453. </ref> and [[William Stokes]] (1804–1877).<ref>W. Stokes. Observations on some cases of permanently slow pulse. Dublin Quarterly Journal of Medical Science, 1846, 2: 73-85.</ref>
| |
|
| |
| == Pathophysiology ==
| |
|
| |
| The attacks are caused by loss of [[cardiac output]] due to cardiac [[asystole]], [[heart block]], or [[ventricular fibrillation]]. The resulting lack of blood flow to the [[brain]] is responsible for the [[syncope]].
| |
|
| |
| == Signs and symptoms ==
| |
|
| |
| Prior to an attack, a patient may become pale, their heart rhythm experiences a temporary pause, and collapse may follow. Normal periods of unconsciousness last approximately thirty seconds; if seizures are present, they will consist of twitching after 15–20 seconds. [[Respiratory system|Breathing]] continues normally throughout the attack, and so on recovery the patient becomes flushed as the heart rapidly pumps the oxygenated blood from the [[pulmonary circulation|pulmonary beds]] into a systemic circulation which has become dilated due to hypoxia.<ref name="Parkland">{{cite book|last = Katz | first = Jason| authorlink = | coauthors = Patel, Chetan| title = Parkland Manual of Inpatient Medicine| publisher = FA Davis| date = 2006| location = Dallas, TX| pages = 903|}}</ref>
| |
|
| |
| As with any syncopal episode that results from a cardiac dysrhythmia, the faints do not depend on the patient's position. If they occur during sleep, the presenting symptom may simply be feeling hot and flushed on waking.<ref name="Parkland"/>
| |
|
| |
| == Diagnosis ==
| |
|
| |
| Stokes-Adams attacks may be diagnosed from the [[Medical history|history]], with paleness prior to the attack and flushing after it particularly characteristic. The [[Electrocardiogram|ECG]] will show asystole or [[ventricular fibrillation]] during the attacks.
| |
|
| |
| == Treatment ==
| |
|
| |
| Initial treatment can be medical, involving the use of drugs like [[isoproterenol]] ([[Isuprel]])and [[epinephrine]] ([[Adrenalin]]). Definitive treatment is [[surgery|surgical]], involving the insertion of a [[artificial pacemaker|pacemaker]] – most likely one with sequential pacing such as a DDI mode as opposed to the older VVI mechanisms. <ref name="Parkland"/>
| |
|
| |
| == Prognosis ==
| |
|
| |
| If undiagnosed (or untreated), Stokes-Adams attacks have a 50% mortality within a year of the first episode. The prognosis following treatment is very good.
| |
|
| |
| == References ==
| |
| {{Reflist}}
| |
|
| |
|
| [[Category:Cardiology]] | | [[Category:Cardiology]] |