Adams-Stokes syndrome

Adams-Stokes syndrome: Description: A syndrome characterized by slow or absent pulse, vertigo, syncope, convulsions, and sometimes Cheyne-Stokes respiration; usually as a result of advanced AV block or sick sinus syndrome. Alternative Names: Morgagni disease, Adams-Stokes disease, Stokes-Adams disease, Morgagni-Adams-Stokes syndrome, Stokes-Adams syndrome, and Spens syndrome. ICD-9-CM Code: 426.9. The condition is usually associated with ischemic heart disease and so tends to occur in the elderly. Stokes-Adams disease is a sudden, temporary condition in which people faint and, occasionally, experience seizures. The condition is due to a miscommunication in the heart's electrical conduction system that causes the heart to slow. As a result, there is a temporary interruption in the supply of oxygen to the brain because the heart is not pumping oxygen-rich blood quickly enough to meet the brain's needs. In this condition, the normal heartbeat passing from the upper chambers of the heart to the lower chambers is interrupted. This results in a condition called a "heart block." When a heart block occurs, the heart rate usually slows considerably. This can cause inadequate blood flow to the brain and result in fainting. While this disease almost invariably has a pathology, cases have occurred in which no lesion of the heart could be found, but it generally occurs coincidently with arteriosclerosis, in which the coronary arteries are more or less involved and the arterial system of the brain may be diseased. It occurs more frequently in men than in women and in them mostly after middle, or in advanced. Symptoms: Symptoms include, Palpitations, dizziness, feeling confused, coldness, and sweating. Causes and Risk Factors: Adams-Stokes syndrome Adams-Stokes syndrome attacks may be caused by a number of factors, which include: Certain medications: These include beta blockers, calcium channel blockers and digoxin.
  • Heart diseases that affect the AV node. The AV node plays an important role in maintaining proper communication between the upper and lower chambers of the heart.
  • Certain neuromuscular conditions (e.g., muscular dystrophy).
  • Surgical trauma such as the repair of a heart defect or replacement of valves.
Adams-Stokes syndrome attacks have been described as due to:
  • Chronic or paroxysmal atrioventricular (AV) block in 50 to 60% of patients.
  • Paroxysmal supraventricular tachycardia or atrial fibrillation in up to 5%.
  • Sinoatrial (SA) block in 30 to 40%.
The risk of developing Adams-Stokes syndrome is also increased by certain connective tissue diseases that involve the heart, including a condition in which the body's immune system fights against itself (an autoimmune disorder) called lupus. Complications include cardiomyopathies, myocarditis and certain malignancies such as Hodgkin's disease. Indications There is collapse, usually without warning.
  • Loss of consciousness is usually between about 10 and 30 seconds.
  • Some seizure-like activity sometimes occurs if the attack is prolonged.
  • If anyone manages to check the pulse during an episode, it will be slow, usually less than 40 beats per minute.
  • Recovery is fairly rapid although the patient may be confused for a while after.
  • Typically complete (third degree) heart block is seen on the ECG during an attack but other ECG abnormalities such as tachy-brady syndrome have been reported..
  • Attacks can happen a number of times in one day.
  • They are not posture related.
Diagnosis: Stokes-Adams attacks may be diagnosed from the history, with paleness prior to the attack and flushing after it particularly characteristic. Tests: Blood Tests: If patients are taking digoxin, the physician will check for the amount of this medication in the patient's bloodstream. An enzyme test will also be important to rule out a recent heart attack. The ECG will show asystole or ventricular fibrillation during the attacks. Cardiac Catheterization: A common, minimally invasive procedure in which a physician inserts a small tube called a catheter into a patient's blood vessel and passes the tube toward the heart. This enables a physician to measure pressures within the heart or detect diseases such as coronary artery disease. Electrophysiology Study: A test that uses an electrode catheter to locate a particular pathway by which electrical impulses travel in the heart, and to determine the extent of any abnormal impulses traveling through it. The physician will be particularly looking for any problems in the AV node. Treatment: Initial treatment can be medical, involving the use of drugs like isoproterenol and epinephrine. 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. The best prevention strategy is to make healthy lifestyle changes that help prevent coronary artery disease and/or heart attack. DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.  


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