Adams-Stokes Syndrome

Adams-Stokes Syndrome General Information

Adams-Stokes Syndrome has its name from an Irish surgeon, Robert Adams (1791–1875) and after an Irish physician, William Stokes (1804–1877), who were both named Regius Professor at the University of Dublin. While Adams focused on a bigger variety of diseases (joint, cardiac, vascular and respiratory), Stokes went only on pulmonary and cardiac diseases, but both created important medical works. What causes the Adam-Stokes Syndrome is a heart rhythm disorder that leads to the transient condition. It manifests as episodes of syncope, sometimes accompanied by seizures and fainting that may produce with or without convulsions. The normal heart beat passing from the upper to lower chambers of the heart is interrupted and the result is known as a heart block characterized by a heart rate that slows significantly. This syndrome has a big variety of different names, for example: Gerbezius-Morgagni-Adams-Stokes Syndrome, Morgani’s Syndrome, Atrio-ventricular Heart Block Syndrome, Spens’ syndrome, Stokes-Adams Syncope/Attack, Gerbec-Morgagni-Adams-Stokes Syndrome, cardiac syncope, Morgani-Adams-Stokes or Stokes Attack/Syndrome. The heart blocks may be complete or not that result from the disturbances of the heart’s conductive path. It is common among people over 45 years old and can develop into heart and brain diseases, being a very important symptom. Only in 1790, Thomas Spens, a respectable physician from Scotland, had a patient of 55 years old that seemed to be suffering of this heart disorder. The descriptions of this syndrome were also made by an Australian physician named Marcus Gerbezius in 1690 and by Giovanni B. Morgagni, an Italian anatomist.

Adams-Stokes Syndrome Symptoms

Usually, in many cases, Adams-Stokes Syndrome manifests suddenly as attacks of unconsciousness and lightheadedness that are seldom transient attacks and can be accompanied or not by convulsions. The disturbances of the conductive path of the heart lead to blocks of the heart that are complete or incomplete. The respiratory pauses may last even a minute along the convulsions and the respiration that changes from fast and deep into a weak and slow one, as the pulse. So that the attacks are the result of the cardiac output that comes after heart block, cardiac asystole and ventricular fibrillation. The symptoms are due to the lack of blood that flows to the brain and usually causes the faints. Before the attack, the patient becomes pale and his heart rhythm may stop for a while, followed by a collapse. He or she may experience unconsciousness periods that last about twenty seconds and seizures that will consist of twitching after another twenty seconds. While suffering the attack, the patient will continue breathing normally. Because the heart pumps in a rapid way the oxygenated blood out of the pulmonary beds, the patient may become flushed. This blood gets into a systemic circulation that has been dilated by the hypoxia.  The faints occur in any position, even when during the sleep, and present just as hot and flushed feelings when he awakes. The syncopal episodes are due to the cardiac dysrhythmia. Other rarer symptoms of Adams-Stokes Syndrome are fixed pupils, flushing of the face, a bilateral Babinski sign that occurs with resumption of heartbeats, or incontinence.

Adams-Stokes Syndrome Treatment

The symptoms listed above usually indicate if you have Adams-Stokes Syndrome or not, so that the doctor will look for one of those signs. The doctor must evaluate the patient’s circulation, breathing and airway. Sometimes, before the surgery, is necessary to reduce the carbon dioxide levels by hyperventilation and to reduce the ICP (intracranial pressure). The patient must be continually monitor for having a regular and exact check of his vital signs because there can appear a widening of the pulse pressure and bradycardia. Hardly after he or she has the breathing, circulation and airway stabilized, the surgery may be preceded. You should always seek medical guidance if you present these symptoms. A planning for Adams-Stokes Syndrome must contain these following treatments: artificial pacemaker, emergency treatment in the cases when the patient does not recover quickly from the unconsciousness, treatments of arrhythmia, CPR (cardiopulmonary resuscitation), treatments for the underlying causes, and most important, the first aid, mostly when the fainting occurs.

In order to establish the right diagnose, the doctor must also check the pulse rate. Very important for your health care provider to discover if you have this disease is to know the health history of the family, especially the attacks and the flushing. The attacks are watched using an ECG that shows the ventricular and asystole fibrillation while the attack lasts. The ECG is used along a Holter monitor 24 hours to have a better diagnose determination. The time of any attack should be noted by the patient himself or by a nurse or companion that should be put in relation with the bradycardia on the ECG. Nowadays, the modern machines can monitor the patient for a longer period, recording themselves the times of the attacks, making the doctors work easier. If it is not discovered on time and not treated adequate, Adams-Stokes Syndrome has a big mortality rate, over 45% within a year after the incidence of the first attack. But if the right treatment is applied on time, the prognosis for the disease is not that worrying anymore. The initial treatment consists in medicines giving either orally or intravenously, such as adrenalin (epinephrine) or isuprel (isoproterenol).

After this medical treatment, the definitive one is surgical and consists in the insertion of a pacemaker. The most used pacemakers are DDI mode (those with sequential pacing) or some older ones, VVI mechanisms. Because Adams-Stokes Syndrome usually involves a physical problem, the surgery is needed in most cases. After the intervention the patient is advised to have bed rest as much as possible, to avoid cigarettes and alcohol, get angry and efforts. It is very hard to prevent the syndrome, even if not impossible. All you have to do is to keep your heart strong and healthy and to have a healthy life. Because patients often faint when they suffer of Adams-Stokes Syndrome, it is important that the relatives and the close friends to know to take his vital signs and to ensure him or her patents airway. The person must be placed in a supine position, with the legs elevated and without any tight clothes on him.