Adams-Stokes Syndrome

ADAMON (Adamon), dibromo-dihydrocoriennic acid ether of borneol with 35% borneol and 35% bromine; possesses simultaneously the action of bromine and valerian (borneol), without their unpleasant taste, is applied in neuroses, nervous palpitations, hysteria, and during climacteric. Dosage: three times a day 0.5. (Adams-Stokes; more correctly-Edems-Stoksa), a state of prolonged bradycardia, sometimes increasing up to the stopping of the heart and accompanied by an unconscious state with epileptoid and apoplectic-like convulsions. The syndrome was named so by Huchard after the Irish doctors who described it in the first half of the 19th century; as Pletnev showed, this symptom complex was described as early as the middle of the 18th century by Morgagni and is now mentioned in literature under the name of the Morgagni-Adams-Stokes symptom complex. The onset of the unconscious state and convulsions is linked to anemia of the brain, which is the result of circulatory insufficiency, due to sharp bradycardia, tachysystole of the ventricles, or complete stopping of them. The cause of bradycardia was sought either in the action of the vagus nerve on the heart (Charcot) or in the heart itself. Pletnev subdivides the syndrome into two types: the Morgagni type - neurogenic and the Adams-Stokes type - cardiogenic. The first type includes those cases in which the heart at autopsy shows no changes, while changes are found on the side of the nervous system (e.g., gummas of the cerebellar peduncles, varicose dilation in the area of the decussation of the pyramids, etc.). In the cardiogenic type, in turn, some authors (Pletnev, Aschoff, Nagayo) distinguish two forms - with damage to the conducting system and with damage only to the muscular tissue of the ventricles. In the form characterized by damage to the conducting system and accompanied by transverse dissociation, two types should be distinguished: 1) with sino-auricular and 2) with auriculo-ventricular block. In the first, the heart does not stop for long, because atrioventricular automatism occurs quite quickly; death during an attack was never observed (Wenckebach). In the second case, the occurrence of an attack is possible with the transition of a partial block into a complete one, due to the onset of a pre-automatic pause, as well as with the presence of a constant complete block. Path.-anat. in cardiogenic cases find myocarditis, myodegeneration (Adams-Stokes), formation of scars, calcified nodes (Nagayo), tumors (Armstrong, Monckeberg) compressing and destroying the conducting system, etc. Clinically the syndrome can be expressed sharply, giving the classic picture described by Morgagni-Adams-Stokes, or manifest in the form of "stamped" forms (formes frustes). In a fully expressed picture, the stopping of the ventricles can last from several seconds to several minutes. The unconscious state and convulsions appearing during the stopping of the ventricles usually last not long: their duration depends on the attack for more than x/2-1/2 hour only in rare cases (Wenckebach). Attacks are sometimes accompanied by severe disorders of respiratory rhythm (Chains-Stokes breathing). The attack ends with the resumption of ventricular contractions and the return of consciousness or death. The frequency of attacks is sometimes very great. Between attacks there can be not only permanent bradycardia, but also almost normal pulse frequency (Huchard) or even tachycardia (Volhard). In formes frustes (Huchard) an attack can express only bradycardia with pallor or dizziness; there are also transitional forms from such reduced to fully expressed attacks. In objective examination, Stokes already noted that sometimes the number of waves on the jugular veins is greater than the number of pulse beats; upon listening between the tones (or noises) corresponding to the cardiac impulse, dull tones are noted, depending, probably, on the contraction of the atria (semi-beats of Stokes, systolic bruits in echo of Huchard); sometimes a "cannon" sound is heard, which corresponds to a large wave on the jugular veins, explained by the coincidence of the systole of the atrium and the ventricle; the double sound heard in some cases depends on various combinations of the sequence between the contractions of the atria and the ventricles (Strazhesko). On roentgenoscopy, dissociation between the contractions of the atria and the ventricles is noted; this dissociation is best detected on the electrocardiogram and on the curves of arterial and venous pulse. The diagnosis in most cases does not present difficulties. From cerebral apoplexy it is distinguished by the short duration of the unconscious state and the absence of paralysis after the attack. From the neurogenic form of the syndrome it is necessary to distinguish all states in which, due to anemia of the brain or other causes, an unconscious state occurs with subsequent bradycardia (Wenckebach).- The prognosis depends on the underlying disease causing the Morgagni-Adams-Stokes syndrome; in most cases it is severe, even in formes frustes; it is more favorable where there is reason to assume syphilitic damage to the myocardium, and therefore to count on improvement from specific treatment.- Treatment. During an attack, intracardiac and subcutaneous injections of adrenaline, heart massage, artificial respiration are applied; Hoffmann successfully gave oxygen to inhale. Between attacks, atropine is applied, which, however, accelerating the rhythm of the atria, can intensify transverse dissociation (Folgard, Wenckebach). According to Wenckebach, the overestimation of the significance of the vagus nerve in disorders of conductivity is the reason why digitalis is considered contraindicated in the Morgagni-Adams-Stokes syndrome; Folgard in one case of dissociation achieved recovery of conductivity with the treatment of digipotassium. In recent years, the application of barium chloride in the Morgagni-Adams-Stokes syndrome has been tried.