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.

cardiovascular
Heart Disease
  • Underlying heart disease should be managed appropriately.[patient.info]
  • Learn more about diabetes from the Heart disease .[cardiachealth.org]
  • 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]
  • 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.[medigoo.com]
  • 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]
Slow Pulse
  • 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]
  • Observations on some cases of permanently slow pulse. Dublin Quarterly Journal of Medical Science, 1846, 2: 73–85. "Stokes-Adams; Adams-Stokes; Morgagni-Adams-Stokes Attacks" . patient.info . a b c Katz, Jason; Patel, Chetan (2006).[en.wikipedia.org]
  • Wooley CF, Bliss M ; William Osler: slow pulse, stokes-adams disease, and sudden death in families.[patient.info]
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]
  • 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]
  • ( G90.3 ) orthostatic hypotension ( I95.1 ) postprocedural shock ( T81.1- ) psychogenic syncope ( F48.8 ) shock NOS ( R57.9 ) shock complicating or following abortion or ectopic or molar pregnancy ( O00 - O07 , O08.3 ) shock complicating or following[icd10data.com]
  • Tachycardia or hypotension should be noted.[ahcmedia.com]
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  • neurologic
    Seizure
    • 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]
    • 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]
    • The patient may experience a sudden episode of bradycardia or absence of pulse and syncope that may be followed by epileptic seizures.[symptoma.com]
    • 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.[medigoo.com]
    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]
    • Symptoms: Symptoms include, Palpitations, dizziness , feeling confused, coldness, and sweating.[medigoo.com]
    • 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 Sudden trouble walking, dizziness[cardiachealth.org]
    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]
  • more...
  • Entire body system
    Coronary Artery Disease
    • This enables a physician to measure pressures within the heart or detect diseases such as coronary artery disease.[medigoo.com]
    • 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]
    • 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]
    • Patients who develop complete heart block from coronary artery disease (CAD) usually have prior evidence of conduction disease if, in fact, previous ECGs are available. There are, of course, other causes of chronic progressive heart block.[ahcmedia.com]
    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]
  • more...
  • 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.

    Test Results

    Other Test Results
  • more...
  • Treatment

    Prognosis

    Complications

    Sudden Death
    • Stokes-Adams attacks represent an emergency because of the possibility of sudden death. Congenital heart block without attacks is compatible with a normal life expectancy.[pediatrics.aappublications.org]
    • Wooley CF, Bliss M ; William Osler: slow pulse, stokes-adams disease, and sudden death in families.[patient.info]
    • death; 83% of these individuals experience sudden death at 30 months (vs 32% in patients with cardiomyopathy and no syncope). 42 Finally, patients with mechanical pacemakers should undergo careful pacemaker interrogation, since intrinsic pacemaker abnormalities[ahcmedia.com]
    • Nonsustained ventricular tachycardia in patients with significant left ventricular dysfunction (ejection fraction 40%) correlates with a risk of sudden death from sustained ventricular arrhythmias and warrants further electrophysiologic evaluation (see[homeopathyworldcommunity.ning.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]
    • 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]
    • ( G90.3 ) orthostatic hypotension ( I95.1 ) postprocedural shock ( T81.1- ) psychogenic syncope ( F48.8 ) shock NOS ( R57.9 ) shock complicating or following abortion or ectopic or molar pregnancy ( O00 - O07 , O08.3 ) shock complicating or following[icd10data.com]
    • Tachycardia or hypotension should be noted.[ahcmedia.com]
    Cardiac Arrest
    • arrest - Sudden cardiac death Arrhythmia : Paroxysmal tachycardia ( Supraventricular , AV nodal reentrant , Ventricular ) - Atrial flutter - Atrial fibrillation ( Familial ) - Ventricular fibrillation - Premature contraction ( Atrial , Ventricular )[wikidoc.org]
    • Adams Stokes Attack is due to cardiac arrest usually in systole but occasionally in ventricular fibrillation on a basis of atrioventricular block.[healthatoz.info]
    • In this case, the person may experience a Stokes-Adams attack, cardiac arrest, or SCD. ... Radar 10 Syncope Arrhythmias Harrison's Principles of Internal Medicine ... of sufficient severity to cause syncope.[homeopathyworldcommunity.ning.com]
    • arrest due to underlying cardiac condition I46.8 Cardiac arrest due to other underlying condition I46.9 Cardiac arrest, cause unspecified I47 Paroxysmal tachycardia I47.0 Re-entry ventricular arrhythmia I47.1 Supraventricular tachycardia I47.2 Ventricular[icd10data.com]
    • First reported case of temporary cardiac arrest with syncopal attacks. G. B. Morgagni: De sedibus, et causis morborum per anatomen indagatis libri quinque. 2 volums. in 1. Venetis, typ. Remondiniana 1761.[whonamedit.com]
    Syncope
    • ; Stokes Adams attacks and cardiovascular syncope.[patient.info]
    • Adams-Stokes syncope - syncope due to complete atrioventricular block. Stokes, William, Irish physician, 1804-1878.[medical-dictionary.thefreedictionary.com]
    • This prolonged period of asystole may result in syncope and Stokes-Adams attack with a complete recovery of the consciousness once the cardiac activity is resumed.[bmj.com]
    • D'autres signes neurologiques peuvent avoir une signification équivalente à la syncope : impression de brouillard, de voile devant les yeux, sensation de vertige, de perte de connaissance imminente.[larousse.fr]
    Acute Myocardial Infarction
    • myocardial infarction In 2-7% of patients with acute myocardial infarction, is complicated with complete heart block[1] History of neoplastic disease Primary or secondary neoplasms infiltrating the myocardium and the conducting system can also produce[explainmedicine.com]
    Coronary Artery Disease
    • This enables a physician to measure pressures within the heart or detect diseases such as coronary artery disease.[medigoo.com]
    • 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]
    • 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]
    • Patients who develop complete heart block from coronary artery disease (CAD) usually have prior evidence of conduction disease if, in fact, previous ECGs are available. There are, of course, other causes of chronic progressive heart block.[ahcmedia.com]
    Transient Ischemic Attack
    • ischemic attack - Intracranial hemorrhage / cerebral hemorrhage : Extra-axial hemorrhage ( Epidural hemorrhage , Subdural hemorrhage , Subarachnoid hemorrhage ) Intra-axial hematoma ( Intraventricular hemorrhages , Intraparenchymal hemorrhage ) - Anterior[wikidoc.org]
    • Medical conditions that increase your stroke risk: Previous stroke or “mini-stroke” (transient ischemic attack, TIA) .[cardiachealth.org]
    • Syncope in the elderly patient is frequently attributed to transient ischemic attacks (TIAs).[ahcmedia.com]
    Bradycardia
    • Adam-Stokes Attacks, Stokes-Adams Stokes-Adams Attacks Stokes-Adams Syndrome Stokes Adams Attacks Stokes Adams Syndrome Syndrome, Stokes-Adams SCOPE NOTE A condition of fainting spells caused by heart block, often an atrioventricular block, that leads to BRADYCARDIA[finto.fi]
    • Adams' description of syncope associated with bradycardia dates back to 1827 and Stokes described the same association in 1846. (Stokes is also remembered for Cheyne-Stokes breathing .)[patient.info]
    • Marked bradycardia caused by high-grade atrioventricular block or sinus node disease may precipitate an episode of torsade de pointes by prolonging the QT interval to a greater degree than expected merely from the physiologically slowed heart rates [1[bmj.com]
    • With congenital heart block, it has been described as being precipitated by bradycardia or tachycardia.[homeopathyworldcommunity.ning.com]
    • For example, bradycardia due to complete heart block . Signs and symptoms Typically an attack occurs without warning leading to sudden loss of consciousness. [4] Prior to an attack, a patient may be pale with hypoperfusion.[ipfs.io]

    Etiology

    Epidemiology

    Sex distribution
    Age distribution

    Pathophysiology

    Prevention

    Summary

    Patient Information

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    References

    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.

    1. Adams-Stokes syndrome: A review and follow-up study of forty-two cases∗ - BW Johansson - The American journal of cardiology, 1961 - Elsevier
    2. Adams-Stokes syndrome associated with chronic heart block treatment with corticosteroids - CK Friedberg, M Kahn, J Scheuer - JAMA: The Journal of , 1960 - Am Med Assoc
    3. Atrial single chamber pacing (AAI) and ventricular single chamber pacing (VVI) with respect to prognosis and antiarrhythmic effect in patients with sick sinus syndrome - K Stangl, K Seitz, A Wirtzfeld, E Alt - Pacing and Clinical , 1990 - Wiley Online Library
    4. Adams-Stokes syndrome due to sinoatrial block - OF Müller, D Finkelstein - The American Journal of Cardiology, 1966 - Elsevier
    5. Adams-Stokes seizures due to ventricular tachydysrhythmias in patients with heart block: prevalence and problems of management. - G Jensen, B Sigurd, E Sandoe - CHEST Journal, 1975 - journal.publications.chestnet.org
    6. A variant form of angina pectoris with recurrent transient complete heart block - RE Botti - The American Journal of Cardiology, 1966 - Elsevier
    7. Cardiac conduction in patients with symptomatic sinus node disease - KM ROSEN, HS LOEB, MZ SINNO, SH RAHIMTOOLA - Circulation, 1971 - Am Heart Assoc
    8. ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices--summary article: a report of the American - G Gregoratos, J Abrams, AE Epstein - Journal of the , 2002 - Am Coll Cardio Found
    9. Adams-Stokes syndrome caused by paroxysmal third-degree atrioventricular block. - G Jensen, B Sigurd, J Meibom, E Sandoe - British heart journal, 1973 - ncbi.nlm.nih.gov
    10. Cerebral circulation and function in Cheyne-Stokes respiration - HR Karp, HO Sieker, A Heyman - The American journal of medicine, 1961 - Elsevier
    11. Artificial pacemaker for treatment of Adams-Stokes syndrome and slow heart rate - R Elmgvist, J Landegren, SO Pettersson - American Heart , 1963 - Elsevier
    12. A case of complete heart-block with interesting reaction to drugs - EH Drake - American Heart Journal, 1928 - Elsevier
    13. Adams-Stokes syndrome: The treatment of ventricular asystole, ventricular tachycardia and ventricular fibrillation associated with complete heart block - SR Robbin, S Goldfein, MJ Schwartz, S Dack - The American Journal of , 1955 - Elsevier
    14. 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices--summary article: a report of the American College of Cardiology/ - G Gregoratos, J Abrams, AE Epstein - of Cardiology, 2002 - Am Coll Cardio Found

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