Adams-Stokes Syndrome

Adams–Stokes Syndrome – Treatment Options

Introduction
Adams–Stokes syndrome refers to transient episodes of syncope caused by a sudden decrease in cerebral perfusion, usually due to transient arrhythmias (most often complete heart block, sinus arrest, or ventricular tachyarrhythmias). Patients may present with sudden loss of consciousness, pallor followed by flushing, and sometimes seizures due to cerebral hypoxia. The episodes are typically brief but recurrent and can be life-threatening without intervention.

1. Acute Management of an Attack

• Airway, Breathing, Circulation (ABC): Ensure airway patency, provide supplemental oxygen, and support circulation.

• Positioning: Supine position with elevated legs to enhance cerebral blood flow.

• Cardiopulmonary resuscitation (CPR): Initiated if cardiac arrest occurs.

• Temporary pacing:

  • Intravenous atropine or isoproterenol may be used for bradyarrhythmias.

  • Temporary transcutaneous or transvenous pacing if severe or recurrent episodes.

2. Definitive Therapy

• Permanent pacemaker implantation:

  • Mainstay of treatment in patients with heart block or significant bradyarrhythmia.

  • Restores reliable cardiac rhythm and prevents recurrent syncope.

• Antiarrhythmic therapy:

  • For tachyarrhythmia-induced Adams–Stokes attacks (e.g., amiodarone, beta-blockers, or catheter ablation depending on type of arrhythmia).

• Implantable cardioverter-defibrillator (ICD):

  • Indicated in patients with malignant ventricular tachyarrhythmias at risk of sudden cardiac death.

3. Supportive and Adjunctive Care

• Identify and correct reversible causes:

  • Electrolyte disturbances (potassium, magnesium, calcium).

  • Drug toxicity (digitalis, beta-blockers, calcium channel blockers).

  • Myocardial ischemia or infarction.

• Lifestyle precautions:

  • Avoid situations where syncope could lead to injury (driving, swimming alone, operating machinery) until stabilized.

4. Monitoring and Long-Term Care

• ECG and Holter monitoring: To detect underlying rhythm disturbances.

• Electrophysiological studies: For patients with unexplained syncope and suspected arrhythmia.

• Regular pacemaker/ICD follow-up: Device checks to ensure functionality.

• Risk factor modification: Hypertension, coronary artery disease, and other comorbidities managed aggressively.

5. Multidisciplinary Care

• Cardiologists/electrophysiologists: For pacemaker or ICD implantation and arrhythmia management.

• Emergency teams: For acute stabilization during attacks.

• Neurologists: If seizures are suspected to rule out primary epilepsy.

• Primary care and rehabilitation teams: For long-term follow-up and patient education.