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Adams-Stokes Attacks or Syndrome

There are two important tricks that you need to remember...

First: Differentiate this attack from epileptic seizures and other causes of loss of consciousness. Clues are the lack of respiratory difficulty, no prodrome, no postictal sleep, EKG abnormalities, the pallor, and the flushing (patient feels hot and looks red) after the attack.

Second: You have to know which type of heart block usually predisposes to this attack. It's Type II and Type III. Type I does not usually cause Adams-Stokes.

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 Stokes-Adams syndrome, a rarely reported disease

Stokes-Adams syndrome is defined as a transient loss of consciousness with spontaneous recovery after a decrease in cardiac output that leads to a state of cerebral hypoxia and may cause seizures. It is a rare and poorly documented condition. High-degree atrioventricular block, paroxysmal ventricular arrest, and pulseless ventricular tachycardia have been described as causes, and depending on the case, temporary or permanent pacemaker implantation or cardiac defibrillation may be necessary.

Articles of Interest

Adams-Stokes attack as the first symptom of acute rheumatic fever: report of an adolescent case and review of the literature

Acquired complete heart block, in pediatric age is mainly the results of direct injury to conduction tissue during cardiac surgery or cardiac catheterisation. It can also be observed in different clinical settings as infectious diseases, neoplasia, and inflammatory diseases. It has a wide range of presentation and in some settings it can appear a dramatic event. Although a rare finding during acute rheumatic fever, with a transient course, it may need a specific and intensive treatment.

Management of Stokes-Adams syndrome

Stokes-Adams attacks are related to paroxysmal or chronic atrioventricular (AV) block (50-60%), sinoatrial (SA) block (30-40%) or paroxysmal tachycardia or fibrillation (0-5%). In between attacks most patients present with sinus rhythm, a large part with widened QRS complex. A minor proportion of patients present with chronic AV block. ECG is very rarely normal. Diagnosis is based on ECG recording during fainting. In patients with sinus rhythm and bundle-branch block or AV block, ECG monitoring should be performed in hospital, since Stokes-Adams syndrome in these patients is a potentially life-threatening disease.

Stokes-Adams syndrome

Stokes-Adams syndrome is an abrupt, transient loss of consciousness due to a sudden but pronounced decrease in the cardiac output, which is caused by a paroxysmal shift in the mechanism of the heart beat, usually an atrioventricular block. First descriptions by Gerbezius in 1717 later referenced by Morgagni in 1761 with his two cases. Further description in the English literature by Spens (1792) and Burnett (1824) before the publications of Adams (1827) and Stokes (1846).