What Is Stokes-Adams Attack?
The two Irish physicians who first recognized the Adams-Stokes condition in the 1700s gave it the name Stokes-Adams syndrome, sometimes known as the Stokes-Adams attack. It has been seen in persons of all ages, including the extremely young, despite being typically linked to aging and heart disease.
Stokes-Adams attacks are syncopal episodes caused by cardiac arrhythmia, most frequently bradycardia (slow heart rate) in the form of sick sinus syndrome, total heart block (Lev's disease), or second-degree type II AV block. A sudden collapse and brief loss of consciousness are characteristics of a Stokes-Adams attack. On the electrocardiogram or ECG during an attack, a complete or third-degree heart block is typically visible. These attacks may or may not be accompanied by seizures. Since there is no medical therapy that may correct the innate cardiac conduction disorder, the only option for treatment is lifelong pacemaker placement.
What Is the Epidemiology of the Condition?
The disorder typically affects older people since it is linked to coronary heart disease. Many younger individuals, including people who have congenital heart block, have experienced Stokes-Adams attacks. Stokes-Adams attacks might be more common in certain families.
What Causes a Stokes-Adams Attack?
When the electrical signals that regulate the heart rate are disrupted, Stokes-Adams syndrome develops. Attacks are brought on by any momentary decrease in cardiac output brought on by a momentary aberrant heart rhythm. Up to five percent of patients in one series had paroxysmal supraventricular tachycardia or atrial fibrillation as the underlying etiology. The loss of consciousness and related fainting episodes are brought on by the consequent reduction in blood supply to the brain.
What Are the Symptoms of a Stokes-Adams Attack?
Usually, an episode comes on suddenly, leaving the individual unconscious. A patient may appear pale and have hypoperfusion before an episode.
After 15 to 20 seconds of unconsciousness, abnormal movements, usually consisting of twitching, may be observed. Unlike epileptiform seizures, which are caused by cortical discharge, these movements, which are not seizures, are caused by brainstem hypoxia. Although the period of unconsciousness is usually brief, the symptoms can persist anywhere from minutes to hours.
The patient breathes regularly throughout the attack, and when it is done, the heart quickly pumps oxygenated blood from the pulmonary beds into the systemic circulatory system, which has dilated owing to hypoxia (low level of oxygen in the body tissues). This causes the patient to flush red. They collapse and immediately wake up, usually feeling lost.
Similar to any syncopal episode brought on by cardiac dysrhythmia, the fainting is not position-dependent. The presenting symptom, if it happens while one is sleeping, can just be feeling warm and flushed when one wakes up.
Adam-Stokes syndrome symptoms might vary, but many individuals report:
- Lightheadedness.
- Dizziness.
- Paleness of skin.
- Sweating.
- Twitches.
- Abnormal pulse.
What Is the Estimated Frequency of Adams-Stokes Syndrome?
In older persons who are predisposed to heart disease, it is relatively prevalent. Younger people with an abnormal heart rate can potentially develop it. After age 50, Adams-Stokes syndrome is most prevalent. On the other hand, about 30 % of patients had their first attack before the age of 50. Despite being regarded as a syndrome, it is a sign of an undiagnosed underlying heart problem.
How to Diagnose Stokes-Adams Syndrome?
By inquiring about the patient's past medical history and fainting spells, the doctor can determine if the patient had a Stokes-Adams attack. The physician would inquire if the individual was pale before the attacks and reddish afterward.
The heart rate and the blood pressure of the patient will be checked by the doctor. An electrocardiogram (EKG) will be performed on them to check for cardiac rhythm issues.
Other examinations can involve an exercise stress test, an echocardiography (a heart ultrasound), or a Holter monitor, a wearable device that records heartbeats.
How to Treat Stokes-Adams Syndrome?
To stop additional attacks, the underlying cardiac disease must be treated. The exact heart rhythm problem and its underlying cause will determine the treatment strategy. Some causes are simple to treat. With the use of supplements, electrolyte imbalances can be controlled. Medication can be used to correct hormonal deficits. Blood channel obstructions may need more therapy if there is limited blood flow to the heart.
The heart rhythm can be stabilized, and fainting spells can be avoided with pacemaker implantation. The heart receives electrical impulses from this tiny device placed beneath the skin, which regulates the heart's beating frequency. Until the doctors can identify and treat the underlying cardiac issue, the heart pacing may only be temporary. If necessary, it might also be permanent.
How to Manage Stokes-Adams Syndrome?
As the oral drug treatment is ineffective in Stokes-Adams syndrome, pacemaker implantation should be performed. The dual-chamber pacemaker has advantages of physiological heart rate and AV synchrony but they have troublesome side-effects.
What Are the Risk Factors for Strokes-Adams Syndrome?
Risk factors for Strokes- Adams Syndrome are:
- History of heart disease.
- History of bundle branch block.
- Older than age 60.
- Having a family history of heart disease or abnormal heart rhythms.
What Are the Possible Complications?
There are two potential side effects of Adams-Stokes syndrome. There are difficulties connected with the underlying heart issue as well as those brought on by the fainting spell. Heart blood artery blockages that are left untreated can result in heart tissue scarring, weakened heart muscle, erratic heart rhythms, and unexpected cardiac arrest. There is also a serious safety hazard because these spells can occur anytime and anywhere. For instance, they might take place whilst they are operating a vehicle. The fall itself could cause them harm. It is crucial to seek quick medical attention if an individual encounters fainting spells. The leading cause of death in many countries is coronary heart disease, which frequently remains untreated.
Conclusion:
Stokes-Adams is a severe illness. Compared to younger people, older folks are more susceptible to major issues. However, with therapy, the chances of living a longer life increase. The only thing one can do to prevent Stokes-Adams is to maintain a regular heartbeat because an irregular heart rhythm is what causes the condition. A pacemaker is the most effective tool for this.
