Stokes- Adams Syndrome

Stokes Adams syndrome (SAS) or Adams-Stokes syndrome is a condition in which a person lose consciousness and faint without warning and can pass out.
It is caused due to intermittent complete heart block or due to change in heart rate which causes loss of spontaneous circulation and blood flow to brain.
It is named after two Irish physicians, Robert Adams and William Stokes.

Causes of Stokes- Adams Syndrome

It may occur after a cardiovascular accident, electrolyte disturbance, disease of AV node, heart disease and rheumatic disease.

Main feature is sudden loss of consciousness or fainting without any warning which may last for 10-15 seconds. Before fainting, the skin may turn pale due to hypoperfusion. Abnormal movement like twitching may occur after 15-20 seconds of unconsciousness.
Heartbeat may decrease up to 40 beats/minute during the episode.
Recovery occurs fast but the patient may feel confused after. On recovery, patient become flushed as heart rapidly pumps oxygenated blood.
Multiple episodes of SAS may occur in a single day.

The diagnosis depends on medical history of patient. Other tests could include an echocardiogram, an exercise stress test or a Holter monitor (a wearable machine that records heart rhythm).
The ECG will show complete heart block, AV block or other arrhythmia during the attack.

Treatment focus on managing the underlying condition that causes the symptoms.
Initial treatment involves use of drugs like isoprenaline and epinephrine. The most effective treatment is insertion of permanent cardiac pacemaker.
Patients with SAS should be forbidden from performing tasks like cycling, driving, operating machines until the symptoms are managed with the aid of a pacemaker.