Friday, February 8, 2008


A 55 year old man presents to your cardiology clinic. He says that last week, he had an episode of fainting. He was sitting on the couch watching TV when he became extremely pale. He felt his heart "skip a beat." He then swooned into the arms of his wife who promptly dropped him to the ground. Once he hit the ground, he began to twitch for 15 seconds. About 15 seconds after he stopped twitching, he regained consciousness. After that, he became extremely flushed. He went to see his primary care doctor who referred him to you.

He is bradycardic and hypotensive. You look at the EKG taken by the primary care doctor.

Challenge: This syndrome is named after two Irish doctors. What is the syndrome?

Related Questions:
1. What does the EKG show?
2. What causes the syncope?

Image is in the public domain.

1 comment:

Craig said...


This would be Adams-Stokes syndrome described by Robert Adams (1791-1875) and William Stokes (1804-1877). It is characterized by a sudden, transient loss of consciousness, possibly including convulsions. The episode is preceded by paleness and followed by flushing. Attacks last about 30 seconds and breathing continues through the attack. During the attack, EKG would show asystole or v-fib. The attacks are caused by cardiac asystole, heart block, or v-fib. The EKG strip shows a third degree AV block with completely uncoupled P waves and QRS complexes. The loss of consciousness is due to loss of blood flow to the brain. Initial treatment includes vasopressors, but definitive treatment for both Adams-Stokes and third degree AV block is pacemaker insertion.

Source: Wikipedia.