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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 :
Heart rate and rhythm are usually analyzed with an EKG (ECG or ElectroCardioGram).
- 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.
Typically, complete (third-degree) heart block is seen on the ECG during an attack.
- 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.
- 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 conditions should be be considered or excluded in a patient suspected of Adams-Stokes:
- Epilepsy (if convulsions occur).
- Vasovagal fainting.
- Carotid sinus hypersensitivity.
- Orthostatic hypotension.
- A fast arrhythmia (may also reduce cardiac output but does not usually have the same brief but dramatic effect).
- Drop attacks.
- Transient ischemic attack (TIA or mini stroke).
- Syncope due to hypovolemia.
- Reversible causes such as drug toxicity should be addressed.
- Underlying heart disease should be managed appropriately.
- A cardiac pacemaker may be required.
Ask Doctor T. Blog
I proactively requested a stress test, at 66, due to not having had one in 10 years and my sister just had emergency CABG, possibly with genetic factors causing the coronary artery disease. Stress test completed, problem found, angiogram done 2 days ago. Two blockages, 90%-95% occlusion of LAD near bifurcation; 75% occlusion of an artery on right side (don't remember...