Synonyms in the broadest sense
Morgagni-Adam-Stokes seizure (MAS seizure)
Definition Adam-Stokes seizure
The Adam Stokes attack is an unconsciousness caused by a temporary cardiac arrest (asystole) from which the patient spontaneously awakens again.
History
The Adam Stokes seizure was named after the two Irish men Robert Adams and William Stokes. However, the symptoms were already described in the 18th century by the Italian pathologist Giovanni Battista Morgagni.
Causes
Various diseases of the electrical excitation conduction system in the heart can trigger an Adam Stokes attack. Since the heart muscle cells need to be tensed as synchronously as possible in order to pump the blood evenly, there are several pacemaker areas in the heart, from which excitation is transmitted to the entire heart via specialized cells. If this transmission is blocked or if the pacemaker is disturbed, the heart cannot or can only partially contract and thus no longer pump blood.
This leads to a functional cardiac arrest. Since no more blood is pumped to the brain, the patient loses consciousness. There are several causes for the disturbance of the excitation conduction system of the heart: In the case of an Adam Stokes attack, the patient regains consciousness after a short period of time, because if a pacemaker system fails, the heart can fall back on subordinate, slower pacemakers that are sufficient for a basic supply of blood to the body.
If this emergency mechanism fails, the patient will not regain consciousness on his own and may die of so-called sudden cardiac death. Since a person affected does not feel any discomfort or sickness before becoming unconscious, it is not uncommon for them to fall and consequently suffer injuries. – For example, a heart attack in an area important for the conduction or generation of stimuli can lead to a corresponding failure. – There is also an increased risk of an Adam Stokes attack in cases of vascular calcification of the heart (arteriosclerosis). – In rare cases, an inflammation of the heart muscle or an overdose of blood pressure or pulse-lowering drugs can also be a trigger.
Symptoms
An affected person loses consciousness without notice and wakes up a short time later. The patients usually have no memory of the event (retrograde amnesia) and may have injured themselves in a fall.
Diagnosis
The diagnosis of an Adam Stokes seizure can sometimes be difficult if the conduction disorder of the heart is not consistent and can be confirmed by a doctor by means of an ECG. If the affected person already has a pacemaker or an implanted defibrillator with built-in memory, disorders can be easily read out afterwards. If irritation disorders are suspected, a long-term ECG may be used to record an event.
