Stokes–Adams disease
| Stokes-Adams syndrome | |
|---|---|
| Classification and external resources | |
| Specialty | cardiology |
| ICD-10 | I45.9 |
| ICD-9-CM | 426.9 |
| DiseasesDB | 12443 |
| MeSH | D000219 |
Stokes–Adams syndrome (alternative eponyms include Adams–Stokes syndrome, Gerbezius-Morgagni-Adams–Stokes syndrome and Gerbec-Morgagni-Adams–Stokes syndrome) is a periodic fainting spell in which there is a periodic onset and offset of blockage of heart due to disorder of heart rhythm that may last for seconds, hours, days, or even weeks before the conduction returns. Named after two Irish physicians, Robert Adams (1791–1875) and William Stokes (1804–1877), the first description of the syndrome was published in 1717 by the Carniolan physician of Slovene descent Marko Gerbec, which was 44 years after its publication quoted by Giovanni Battista Morgagni. It is characterised by decrease in cardiac output and loss of consciousness due to a transient arrhythmia. For example, bradycardia due to complete heart block.
Typically an attack occurs without warning leading to sudden loss of consciousness. Prior to an attack, a patient may be pale with hypoperfusion. 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 brainstem hypoxia and not due to cortical discharge as evident by EEG findings which show no epileptiform activities). Breathing continues normally throughout the attack, and so on recovery the patient becomes flushed as the heart rapidly pumps the oxygenated blood from the pulmonary beds into a systemic circulation which has become dilated due to hypoxia.
As with any syncopal episode that results from a cardiac dysrhythmia, the faints do not depend on the patient's position. If they occur during sleep, the presenting symptom may simply be feeling hot and flushed on waking.
Stokes-Adams attacks may be diagnosed from the history, with paleness prior to the attack and flushing after it particularly characteristic. The ECG will show asystole, an AV block, or ventricular fibrillation during the attacks.
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