Stokes Adams Syndrome

What is Stokes Adams Syndrome?

People may lose consciousness and faint without warning. This condition is known as Stokes Adams Syndrome this condition is associated with decreased blood flow to the heart ^{[1, 2]}.

In Stokes Adams Syndrome (SAS), there is an interruption in the passing of the heartbeat from the atrium to the ventricles. Any disturbance in the conduction of the chambers of the heart is known as a heart block. These disruptions decrease the heart rate and lead to ischemia or decreased blood flow to the heart and brain. If the blood flow to the brain is inadequate, the individual will faint or lose consciousness. This occurs more frequently in the elderly although its occurrence to younger age groups have been increasing ^{[1, 2, 3, 4]}.

This syndrome is named after the scientists William Stokes and Robert Adams. They were the ones who first described the events of this syndrome in 1846 and 1827 respectively. This term that is now used to refer to this syndrome is cardiovascular syncope ^{[1, 4]}.

Causes

Adams Stokes Syndrome may occur after a cardiovascular accident, electrolyte disturbances, diseases of the atrioventricular node, valvular or structural heart diseases and rheumatic diseases. This condition is also worsened by tachycardia or bradycardia ^{[2, 4]}.

Signs and Symptoms

The characteristic feature of this syndrome is fainting or loss of consciousness without warning. This may usually last from 10-30 seconds. The patient may also exhibit seizure-like syndrome especially if the attack last longer. While they are unconscious, they may also exhibit pallor but their normal color will return when they gain consciousness. Recovery from what happened occurs fast but they may feel confused immediately after ^{[1, 2]}.

During the episode, the heart rate may decrease to less than 40 beats per minute. ECG monitoring of these patients may show abnormalities such as third degree heart block and tachy-brady syndrome. SAS attacks may occur multiple times in a single day ^{[1, 2]}.

Diagnosis

Health history and physical examination

Initial examination may include analysis of the patient’s medical history. Occurrence of heart disease in the past should be known. The blood pressure of the patient when they are lying and standing will be examined. Any drugs that the patient are taking may contribute to this syndrome. If there was a seizure-like activity that had been observed previously, the possibility of epilepsy may be looked into ^{[2, 3]}.

Cardiovascular examination

Patients who experience this syndrome may be put under a 24-hour Electrocardiogram (ECG) monitoring. This test will be able to show any changes in the ECG of the patient during a SAS event. Regular monitoring of the serum electrolyte levels must be done to identify any abnormalities that may precipitate this syndrome ^{[2, 3]}.

Treatment

The focus for the management of SAS is to treat the underlying condition that causes the symptoms. If the patient has a concurrent heart disease, it must be managed first before the symptoms of SAS disappear. Patients who experience several bouts of heart blocks in a single day may be required to have a cardiac pacemaker ^{[1, 2, 3, 4]}.

The loss of consciousness typically occurs without any warning and this may put the safety of the patient at risk. Performance of tasks such as driving, operating machinery, swimming, cycling should be forbidden until the bouts of SAS are managed with the aid of a pacemaker ^{[1, 2, 3, 4]}.

References

1. Cardiac Health. (2016). Adams-Stokes Syndrome. Retrieved from Cardiac Health: http://www.cardiachealth.org/adams-stokes-syndrome
2. General Practice Notebook. (2016). Stokes-Adams Attack. Retrieved from General Practice Notebook: http://www.gpnotebook.co.uk/simplepage.cfm?ID=1241907203
3. MedicineNet. (2012, June 12). Definition of Stokes Adams attack. Retrieved from MedicineNet: http://www.medicinenet.com/script/main/art.asp?articlekey=19423
4. Wright, M. (2015, May 21). Stokes-Adams Attacks. Retrieved from Patient.info: http://patient.info/doctor/stokes-adams-attacks