Adams-Stokes Syndrome

In this condition, the normal heartbeat passing from the hearts upper to lower chambers is interrupted. This result in a condition called a “heart block.” When a heart block occurs the heart rate usually slows considerably. This can result in inadequate blood flow to the brain and fainting.Take a look at this animation of your heart's electrical system for a better understanding of what happens normally:

Take a look at this animation of your heart's electrical system for a better understanding :

(From: http://www.nhlbi.nih.gov/health/health-topics/topics/hhw/electrical.html)

Heart rate and rhythm are usually analyzed with an EKG (ECG or ElectroCardioGram).

Symptoms
  • Loss of consciousness is usually between about 10 and 30 seconds.
  • Pallor, followed by flushing on recovery, can be reported.
  • 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 afterwards.
  • Typically, complete (third-degree) heart block is seen on the EKG during an attack.
  • Attacks can happen a number of times in one day.

Diagnosis

Typically, complete (third-degree) heart block is seen on the ECG during an attack.

Causes
  • The condition is usually associated with Coronary artery disease and so tends to occur in the elderly.
  • Stokes-Adams attacks have been reported in much younger age groups, including those with congenital heart block.
  • There may be a familial tendency to Stokes-Adams attacks. This was first recognised by William Osler in 1903, within his own family.

Assessment

  • History of other episodes.
  • Past medical history, including history of heart disease.
  • Drug history: could medication be contributing?
  • Blood pressure examination (supine and standing).
  • EKG: this may be normal by the time the patient is seen or may show heart block.
  • If underlying heart disease is suspected, this should be investigated appropriately.
  • If seizure activity has been witnessed, the possibility of epilepsy should be investigated.
Other possible diagnoses

Other conditions should be be considered or excluded in a patient suspected of Adams-Stokes:

Treatment
  • Reversible causes such as drug toxicity should be addressed.
  • Underlying heart disease should be managed appropriately.
  • A cardiac pacemaker may be required.