The term refers to a sudden, transient episode of (1804–1877).W. Stokes. Observations on some cases of permanently slow pulse. Dublin Quarterly Journal of Medical Science, 1846, 2: 73-85.
Prior to an attack, a patient may become pale, their heart rhythm experiences a temporary pause, and collapse may follow. Normal periods of unconsciousness last approximately thirty seconds; if seizures are present, they will consist of twitching after 15–20 seconds.
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.
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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 or
Ventricular Fibrillation during the attacks.
The attacks are caused by loss of
Cardiac Output due to cardiac
Asystole ,
Heart Block , or ventricular fibrillation. The resulting lack of blood flow to the
Brain is responsible for the faint.
Initial treatment can be medical, involving the use of drugs like
Isoproterenol (
Isuprel )and
Epinephrine (
Adrenalin ). Definitive treatment is
Surgical , involving the insertion of a
Pacemaker – most likely one with sequential pacing such as a
DDI mode as opposed to the older
VVI mechanisms.
If undiagnosed (or untreated), Stokes-Adams attacks have a 50% mortality within a year of the first episode. The prognosis following treatment is very good.
