Adams-Stokes syndrome overview: Difference between revisions
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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">{{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> | *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">{{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> | ||
== References == | == References == | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 08:08, 23 June 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Adams-Stokes syndrome is a sudden collapse into unconsciousness due to a disorder of heart rhythm causing heart blocks in which there is a slow or absent pulse resulting in decreased blood flow to the brain causing syncope (fainting) with or without convulsions. High grade arrhythmias often lead to abrupt decrease in cardiac output and transient loss of consciousness.
Historical Perspective
- It is named after two Irish physicians, Robert Adams (1791–1875)[1] and William Stokes (1804–1877).[2]
- It was first described by Marcus Gerbezius and referenced by Morgagni later in 1761 with his two cases.
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.
Causes
Causes of Adams-Stokes syndrome include asystole, heart block, or ventricular fibrillation
Natural History, Complications and 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.[3]
- However, if attacks occur after a myocardial infarction, the prognosis is bad.[3]
Diagnosis
History and Symptoms
- Stokes-Adams attacks may be diagnosed from the history, with paleness prior to the attack and flushing after recovery is particularly characteristic.
- Loss of consciousness.
- If the attack is prolonged, it may lead to seizure-like-activity.
Physical Examination
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. 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 beds into a systemic circulation which has become dilated due to hypoxia.[4] 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.[4]
Electrocradiogram
- The ECG will show asystole or ventricular fibrillation during the attacks.
- Typically, complete or third heart block is seen on the ECG during an attack but other ECG abnormalities such as tachy-brady syndrome have also been reported.[5]
- Torsades de pointes can also been seen.[6]
Treatment
Medical Therapy
- Initial treatment can be medical, involving the use of drugs like isoproterenol (Isuprel)and epinephrine (Adrenaline).
- Most patients who develop tachycardia or bradycardia syndromes are managed with supplementary anti-arrhythmic treatment.
- Long-term anticoagulation is required in some patients. [7]
Surgery
- Definitive treatment is surgical, involving the insertion of a pacemaker – most likely one with sequential pacing such as a DDI mode as opposed to the older VVI mechanisms. [4]
References
- ↑ R. Adams. Cases of Diseases of the Heart, Accompanied with Pathological Observations. Dublin Hospital Reports, 1827, 4: 353-453.
- ↑ W. Stokes. Observations on some cases of permanently slow pulse. Dublin Quarterly Journal of Medical Science, 1846, 2: 73-85.
- ↑ 3.0 3.1 "Correction to Lancet Infectious Diseases 2020; published online April 29. https://doi.org/10.1016/ S1473-3099(20)30064-5". Lancet Infect Dis. 20 (7): e148. 2020. doi:10.1016/S1473-3099(20)30370-4. PMID 32595044 Check
|pmid=value (help). External link in|title=(help) - ↑ 4.0 4.1 4.2 Katz, Jason (2006). Parkland Manual of Inpatient Medicine. Dallas, TX: FA Davis. p. 903. Unknown parameter
|coauthors=ignored (help) - ↑ Harbison J, Newton JL, Seifer C, Kenny RA (2002). "Stokes Adams attacks and cardiovascular syncope". Lancet. 359 (9301): 158–60. doi:10.1016/s0140-6736(02)07376-2. PMID 11809277.
- ↑ Ernst A, Schlattmann P, Waldfahrer F, Westhofen M (2017). Laryngorhinootologie. 96 (8): 519–521. doi:10.1055/s-0043-113690. PMID 28850992 https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28850992. Missing or empty
|title=(help) - ↑ Sigurd B, Sandøe E (1990). "Management of Stokes-Adams syndrome". Cardiology. 77 (3): 195–208. doi:10.1159/000174601. PMID 2272057.