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Adams-Stokes Syndrome

Morgagni Adams Stokes Syndrome

Adams-Stokes syndrome is a disorder characterized by a sudden and transient loss of consciousness, due to an abrupt episode of change in heart rhythm. The patient may experience a sudden episode of bradycardia or absence of pulse and syncope that may be followed by epileptic seizures. Adams-Stokes syndrome may be caused by a variety of underlying cardiac pathologies and requires a comprehensive cardiovascular examination in order to be diagnosed with accuracy.


Presentation

An Adams-Stokes episode initially manifests with significant pallor, followed by impairment of consciousness that ranges from a fainting tendency to a complete loss of consciousness. The aforementioned episode is elicited by a sudden change in the heart rhythm, that may involve tachyarrhythmia or bradyarrhythmia.

Epileptic seizures without an aura may or may not accompany the Adams-Stokes related episode; their onset is usually acute and unexpected, as is their resolution. Patients tend to resume their prior activity without realizing that epileptic activity has taken place. After the individual has fully regained consciousness, flushing is observed, that can be attributed to reactive hyperemia. The episodes described above may develop regardless of the posture of the patient and may be experienced up to multiple times each day.

Approximately 10% to 20% of all Adams-Stokes syndrome episodes are induced by third-degree sinoatrial block paroxysms [1] [2]. A variety of supraventricular arrhythmias can also be held accountable for the syncopic events observed in Adams-Stokes syndrome and can even co-exist in the same patient [3] [4] [5]. The presence of a well-defined dysrhythmic condition leads to additional symptoms that can aid in the diagnosis of the underlying cause; symptoms most commonly associated with dysrhythmias that can lead to an Adams-Stokes episode include fatigue, palpitations, and discomfort.

Coronary Artery Disease
  • Get comprehensive coverage of all areas of cardiac surgery , including ischemic, valvular, and congenital heart disease; cardiac tumors; constrictive pericarditis; thoracic aortic surgery; cardiac transplantation; coronary artery disease; aortic valve[books.google.com]
  • artery disease and/or heart attack.[medigoo.com]
  • There was no coronary artery disease. A permanent pacer was placed on hospital day 3. This is the final ECG: Perfectly normal paced rhythm. Note that all precordial QRS are negative.[hqmeded-ecg.blogspot.com]
  • . • In coronary artery disease, high blood pressure, aortic and mitral valve diseases may be associated with sick sinus syndrome.  5.[slideshare.net]
Pallor
  • An Adams-Stokes episode initially manifests with significant pallor, followed by impairment of consciousness that ranges from a fainting tendency to a complete loss of consciousness.[symptoma.com]
  • Pallor, followed by flushing on recovery, can be reported. Some seizure-like activity sometimes occurs if the attack is prolonged. [ 1 ] If anyone manages to check the pulse during an episode, it will be slow, usually less than 40 beats per minute.[patient.info]
  • When faintness is related to primary cardiac pathology, there is usually a combination of dermal pallor and cyanosis.[ahcmedia.com]
  • Typically patients develop an initial pallor, followed by facial flush during recovery. An impairment of transmission of the cardiac electrical impulse along the fibers normally responsible impulse propagation.[icd10data.com]
  • Collapse, usually without warning (Psora) Loss of consciousness usually between about 10 and 30 seconds (Psora) Pallor, followed by flushing on recovery (Psora) Occasionally, some seizure-like activity if the attack is prolonged (Psora/ Syphilis) Pulse[homeopathyworldcommunity.ning.com]
Falling
  • The patient with apparent loss of consciousness may present to the ED with myriad complaints, including "falling out," "passing out," or simply "feeling dizzy."[ahcmedia.com]
  • These attacks often occur without warning, there is rapid loss of consciousness and pt. may fall. Convulsions may occur, if heart does not begin to beat within about . 10sec and death will result, if arrest is prolonged 14.[slideshare.net]
Heart Disease
  • Underlying heart disease should be managed appropriately.[patient.info]
  • Learn more about diabetes from the Heart disease .[cardiachealth.org]
  • heart disease THIS IS A DIRECTORY PAGE. Britannica does not currently have an article on this topic.[britannica.com]
  • disease - Hypertensive nephropathy - Secondary hypertension ( Renovascular hypertension ) Ischaemic heart disease Angina pectoris ( Prinzmetal's angina ) - Myocardial infarction (heart attack) - Dressler's syndrome Pulmonary circulation Pulmonary embolism[wikidoc.org]
  • Prime Type your tag names separated by a space and hit enter Authors Source MeSH Adams-Stokes Syndrome Digitalis Glycosides Electrolytes Heart Block Heart Diseases Humans Myocardial Infarction Pub Type(s) Journal Article Language ita PubMed ID 5478830[unboundmedicine.com]
Hypotension
  • ( Orthostatic hypotension ) - Rheumatic fever See also congenital ( Q20-Q28 , 745-747 ) de:Adams-Stokes-Syndrom fi:Adams-Stokesin oireyhtymä Cardiology[wikidoc.org]
  • Orthostatic hypotension . A fast tachyarrhythmia (may also reduce cardiac output but does not usually have the same brief but dramatic effect). Drop attacks. Transient ischaemic attack . Syncope due to hypoperfusion - eg, due to hypovolaemia.[patient.info]
  • Other signs and symptoms include hypotension, heart rate ... ‎2009[educalingo.com]
  • CHEST - HEART failure - accompanied by – hypotension elat. CHEST - HEART failure - accompanied by - pulse; soft glon. CHEST - HEART failure - accompanied by – shock adren. carb-v. kali-c. lach.[homeopathyworldcommunity.ning.com]
Slow Pulse
  • Deep and fast respiration changes to weak and slow pulse and respiration, convulsions and respiratory pauses that may last for 60 seconds.[whonamedit.com]
  • Adams and Stokes found their patients to have fatty degeneration of the cardiac muscle, and considered this to be the cause of the slow pulse and attacks of syncope.[annals.org]
  • Observations on some cases of permanently slow pulse. Dublin Quarterly Journal of Medical Science, 1846, 2: 73–85. 1 2 3 Katz, Jason; Patel, Chetan (2006). Parkland Manual of Inpatient Medicine . Dallas, TX: FA Davis. p. 903.[ipfs.io]
Seizure
  • The patient may experience a sudden episode of bradycardia or absence of pulse and syncope that may be followed by epileptic seizures.[symptoma.com]
  • The aim of this paper is to review the Stokes-Adams attack and its similarity to epileptic seizure with a case report.[agris.fao.org]
  • […] patient develops seizures.[explainmedicine.com]
  • Seizures may or may not accompany these attacks. Treatment is permanent pacemaker implantation as no medical therapy exists to reverse the inherent cardiac conduction pathology. EMAIL PRINT SAVE EMAIL SAVE Previous Next[healio.com]
  • Normal periods of unconsciousness last approximately thirty seconds; if seizures are present, they will consist of twitching after 15 – 20 seconds (seizures occur because of cerebral hypoxia).[ipfs.io]
Dizziness
  • An occasional temporary stoppage or extreme slowing of the pulse as a result of heart block, causing dizziness, fainting, and sometimes convulsions. Also called Stokes-Adams syndrome .[medical-dictionary.thefreedictionary.com]
  • Feeling light headed/ faintness/ dizzy Is due to reduction in cardiac out put as a result of sudden changes in heart rate or rhythm[1][2][4] Loss of consciousness Manifests when blood flow to brain is reduced due to sudden but pronounced decrease in the[explainmedicine.com]
  • […] reported on one of his patients: "… a melancholic, a hypochondriac, otherwise basically healthy, had such a slow pulse that the pulse of a healthy person would beat three times before his pulse would beat for a second time…he was very sluggish, frequently dizzy[whonamedit.com]
  • Symptoms: Symptoms include, Palpitations, dizziness , feeling confused, coldness, and sweating.[medigoo.com]
Confusion
  • Symptoms: Symptoms include, Palpitations, dizziness , feeling confused, coldness, and sweating.[medigoo.com]
  • Top « STROKE SYMPTOMS Common stroke symptoms seen in both men and women: Sudden numbness or weakness of face, arm or leg — especially on one side of the body Sudden confusion, trouble speaking or understanding Sudden trouble seeing in one or both eyes[cardiachealth.org]
  • Recovery is fairly rapid, although the patient may be confused for a while afterwards.[patient.info]
  • MIND - CONFUSION of mind - sleep – after ambr. anac. ars. bry. calc. carb-v. Con. dulc. graph. hep. lach. op. spong. squil. Sulph. uran-n. SKIN - DISCOLORATION – pale Acet-ac. am-c. Anan. androc. Apis ars-s-f. Ars. atra-r. bar-c. bar-s.[homeopathyworldcommunity.ning.com]
Drop Attacks
  • Drop attacks. Transient ischaemic attack . Syncope due to hypoperfusion - eg, due to hypovolaemia. Management Reversible causes such as drug toxicity should be addressed. Underlying heart disease should be managed appropriately.[patient.info]
  • A drop attack with third degree AV block is called a "Stokes Adams" attack, and is often associated with bizarre wide inverted T-waves.[hqmeded-ecg.blogspot.com]
  • (Psora/ Syphilis/ Sycosis) Differential diagnosis A fast tachyarrhythmia (may also reduce cardiac output but does not usually have the same brief but dramatic effect) Carotid sinus hypersensitivity Drop attacks Epilepsy (if convulsions occur) Orthostatic[homeopathyworldcommunity.ning.com]
  • One specific manifestation of vertebrobasilar TIA that both signals its origin and is relatively pathognomonic of vertebrobasilar insufficiency is the so-called "drop" attack or akinetic collapse.[ahcmedia.com]

Workup

Any patient presenting with a syncopic event is required to undergo multiple tests and examinations in order to detect the precise cause of the loss of consciousness. A fainting spell raises suspicion towards Adams-Stokes syndrome, when the patient reports a sudden-onset fainting tendency or loss of consciousness, following otherwise unexplained pallor. After the episode is resolved, the patient typically reports flushing.

For the physician to establish an accurate diagnosis of Adams-Stokes syndrome, many of the following tests should be carried out and evaluated:

  • A comprehensive medical history, including underlying cardiovascular or other pathologies, prior similar episodes and their characteristics, as well as medication history. Digoxin is particularly known for its potential to lead to toxicity, a state which may further cause a third-degree atrioventricular block, amongst others, and an Adams-Stokes episode [6].
  • Blood pressure and heart rate measurement.
  • Electrocardiography (ECG): Although it may appear normal after the resolution of the episode, a 24-hour ECG monitoring will help to illustrate multiple types of dysrhythmia associated with the syndrome [7].
  • Blood tests: Digoxin can be directly measured in the blood. Furthermore, blood tests can detect enzymes associated with myocardial infarction.
  • Cardiac catheterization.
  • Electrophysiologic studies.

A potential Adams-Stokes episode, complicated by convulsions should prompt neurological evaluation as well.

Treatment

  • Treatment Initial treatment can be medical, involving the use of drugs like isoprenaline ( Isuprel ) and epinephrine (adrenaline).[ipfs.io]
  • Has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions.[drugs.com]
  • Treatment [ edit ] Initial treatment can be medical, involving the use of drugs like isoprenaline ( Isuprel ) and epinephrine (adrenaline).[en.wikipedia.org]
  • Despite early treatment 2 patients had repeated palpitations and ECG correlates during the next years.[ncbi.nlm.nih.gov]
  • Most patients with tachycardia/bradycardia syndromes require supplementary anti-arrhythmic treatment, and in some patients additional long-term anticoagulation should be considered.[ncbi.nlm.nih.gov]

Prognosis

  • The prognosis following treatment is very good. References synd/1158 at Who Named It? R. Adams. Cases of Diseases of the Heart, Accompanied with Pathological Observations. Dublin Hospital Reports, 1827, 4: 353–453. W. Stokes.[ipfs.io]
  • The prognosis following treatment is very good. References [ edit ] synd/1158 at Who Named It? R. Adams. Cases of Diseases of the Heart, Accompanied with Pathological Observations. Dublin Hospital Reports, 1827, 4: 353–453. W. Stokes.[en.wikipedia.org]
  • Pathophysiology is emphasized throughout, providing a sound basis for discussions of the diagnosis, treatment, and prognosis that follow.[books.google.com]
  • Morgagni-Adams-Stokes syndrome; Stokes-Adams attack Overview Historical Perspective Pathophysiology Causes Differentiating Adams-Stokes syndrome from other Diseases Epidemiology and Demographics Risk Factors Screening Natural History, Complications and Prognosis[wikidoc.org]
  • Prognosis is good in first degree and in Mobitz type 1,since reliable alternative pacemaker arise from AV junction below the block, if complete heart block develops. Site of block is AV node.[slideshare.net]

Etiology

  • .: Etiology and pathology of bilateral bundle branch block in relation to complete heart block. Progr. cardiovasc. Dis. 6 , 409 (1964). Google Scholar 12. Yater, W. M., Cornell, V.[link.springer.com]
  • In addition, an expeditious approach for pinpointing the etiology of syncopal episodes is presented.[ahcmedia.com]
  • (Syphilis/ Sycosis) Congenital defects Some cases of complete heart block in adults are congenital in etiology, with or without associated cardiac defects. But incidence of Adam Strokes syndrome is common with these patients.[homeopathyworldcommunity.ning.com]
  • The clinical appearance is similar but also etiology entirely different, that caused by cardiac arrhythmia. Occasionally, patients who have syncopes can be treated with antiepileptic drugs.[egetipdergisi.com.tr]

Epidemiology

  • ., M.D. [1] Synonyms and Keywords: Morgagni-Adams-Stokes syndrome; Stokes-Adams attack Overview Historical Perspective Pathophysiology Causes Differentiating Adams-Stokes syndrome from other Diseases Epidemiology and Demographics Risk Factors Screening[wikidoc.org]
  • The development of investigation techniques and improvements in the understanding of the physiology of the cardiovascular system have meant that there has been a move away from clinical diagnoses to a more rigid diagnostic classification. [ 1 ] Epidemiology[patient.info]
  • -The Editor Epidemiology Syncope is a common presenting complaint among patients presenting to the ED and accounts for about 1-6% of all ED visits. 3,4 The Framingham study found a 3.3% incidence of syncope in a cohort of patients followed over a 26-year[ahcmedia.com]
Sex distribution
Age distribution

Pathophysiology

  • This pacemaker is useful not only in the diagnosis of Adams-Stokes syndrome but also in pharmacological and pathophysiological studies and in determining when pacing should cease.[ncbi.nlm.nih.gov]
  • Pathophysiology is emphasized throughout, providing a sound basis for discussions of the diagnosis, treatment, and prognosis that follow.[books.google.com]
  • ., M.D. [1] Synonyms and Keywords: Morgagni-Adams-Stokes syndrome; Stokes-Adams attack Overview Historical Perspective Pathophysiology Causes Differentiating Adams-Stokes syndrome from other Diseases Epidemiology and Demographics Risk Factors Screening[wikidoc.org]
  • Neurocardiogenic syncope: A review of pathophysiology, diagnosis, and treatment. Cardiovasc Reports and Rev 1993;42:22-29. 20. Geogeson S, Linzer M, Griffith JL, et al.[ahcmedia.com]

Prevention

  • We therefore developed a pacemaker for cardiac arrest monitoring and the prevention of Adams-Stokes syndrome and sudden cardiac death, which has the following functions: (1) the longest escape interval of the pacemaker not exceeding the value at which[ncbi.nlm.nih.gov]
  • Top « Medications Antiplatelets: Platelets are blood cells that help the blood to clot and prevent or stop bleeding in case of an injury.[cardiachealth.org]
  • Secondary Prevention Cost Effectiveness of Therapy Future or Investigational Therapies Case Studies Case #1 v t e Circulatory system pathology ( I , 390-459 ) Hypertension Hypertensive heart disease - Hypertensive nephropathy - Secondary hypertension[wikidoc.org]
  • 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[medigoo.com]
  • Medication and/or a cardiac pacemaker may be required to prevent the sudden heart rate changes that prevent adequate flow of blood to the brain Modern surgery began in the mid-19th century with use of anesthetics and antiseptics .[healthatoz.info]

References

Article

  1. Rasmussen K. Chronic sinoatrial heart block. American Heart journal. 1971; 81:38.
  2. Jensen G, Sigurd B, Meibom J, Sandoe E. Adams-Stokes syndrome caused by paroxysmal third-degree atrioventricular block. British Heart Journal, 1973;35: 5I6.
  3. Ferrer MI. The sick sinus syndrome in atrial disease. Journal of the American Medical Association, 1968; 206: 645-46.
  4. Slama R, Waynberger M, Motte G, Bouvrain Y. La maladie rhythmique auriculaire. Archives des Maladies du Coeur et des Vaisseaux, 1969; 62 (3): 297.
  5. Eraut D, Shaw DB. Sinus bradycardia. British Heart Journal, 1971; 33:742.
  6. Eichhorn EJ, Gheorghiade M. Digoxin. Prog cardiovasc dis. 2002; 44 (4): 251–66.
  7. Schlant RC, Adolph RJ, DiMarco JP, et al. Guidelines for electrocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Committee on Electrocardiography). Circulation. 1992 Mar; 85(3):1221-8.

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Last updated: 2018-06-22 01:57