Adams-Stokes syndrome overview
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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 loss of consciousness.
Historical Perspective
It is named after two Irish physicians, Robert Adams (1791–1875)[1] and William Stokes (1804–1877).[2]
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.
Diagnosis
History and Symptoms
Stokes-Adams attacks may be diagnosed from the history, with paleness prior to the attack and flushing after it particularly characteristic.
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.[3] 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.[3]
Electrocradiogram
The ECG will show asystole or ventricular fibrillation during the attacks.
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. [4]
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. [3]
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 3.2 Katz, Jason (2006). Parkland Manual of Inpatient Medicine. Dallas, TX: FA Davis. p. 903. Unknown parameter
|coauthors=ignored (help) - ↑ Sigurd B, Sandøe E (1990). "Management of Stokes-Adams syndrome". Cardiology. 77 (3): 195–208. doi:10.1159/000174601. PMID 2272057.