Hey everyone, it’s Medicine Mondays again. I realize I forgot to post on Friday for Finance Fridays, but I had some house stuff come up which I’ll get into on Wednesday probably. Anyways, today we’re going to talk about Stokes-Adams Syndrome.
Stokes-Adams Syndrome?
Yea.
So, if you had asked me last week what this was, a vague haze would have gone through my mind about this particular eponym. I do recall having heard and learned about this in medical school, along with other eponyms like Wolf-Parkinson-White Syndrome and such.
However, over the weekend a friend of a friend had a sudden onset of this syndrome. I’m going to keep the case presenation pretty generalized and not give too many details, but here’s the story:
Case Presentation
Early 50s male wakes up like normal at 5:30 am and goes downstairs to prepare his coffee for the morning. He has sudden onset of syncope where he collapses to the floor. He is able to stand after a short time under his own power, but “doesn’t feel right”. Fortunately, he is able to go upstairs and wake his wife and tell her “I think I should go to the ER.”
They drive to the ER in a hurry and the ER does an EKG immediately. They find out he is in complete heart block. He proceeds to go into cardiac arrest while in the ER. The ER Physician and Cardiologist perform ACLS and take him out of asystole. They hurriedly get a transcutaenous pacer in an attempt to provide some sort of backup in case he goes bradycardic or into asystole again.
A short while later they are able to implant a permanent pacemaker successfully. The patient is able to go home a few days later, and if you were to meet him on the street, no one would know the life and death ordeal he just survived. In fact, he only plans to drop down to “part time”, and will be returning to work next week.
He was lucky.
Some of you may be surprised that he is going back to work so quickly. However, you may have guessed that this person is a doctor, and he has patients to see and colleagues that rely on him for his expertise.
He’s a genuinely good guy and probably feels a responsibility to both his patients and colleagues.
How common is this kind of presentation?
Actually, this probably a pretty common presentation. Most of the patients present in their early 50s while some may have their first “attack” in their late 40s. For people who have a history of “syncopal episodes”, this can sometimes be diagnosed with Holter monitoring in the outpatient setting.
However, in the case above, if he had gone into asystole away from the hospital, it is unlikely that he would have survived without an AED somewhere.
For you ER guys and Cardiologists, you probably see this happen a lot. However, since I don’t really have face-to-face patient care anymore, I’ve kind of lost this part of my knowledge base. It’s still there and I can vaguely recall it to jog my memory, but it was good look into it again.
TL;DR
Stokes-Adams Syndrome is a not uncommon reason for syncope due to electrical conduction problems of the heart.
While some may suffer minor syncopal episodes and be diagnosed in the outpatient setting, some may present acutely with new syncope, bradycardia, and asystole.
Life is short. Be happy.
-Sensei
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