Stokes Adams Disease Heart Block


Categories: Uncategorized
Sources: Disturbances Of The Heart

Stokes-Adams disease, or the Stokes-Adams syndrome, is a name

applied to a combination of symptoms which was described by Stokes

in 1846, and had been observed by Adams in 1827. The disease is

characterized by bradycardia and cerebral attacks, either syncope or

pseudo-apoplectic or convulsive attacks.



To understand the phenomena of this disease, it will be well to

refer to the first chapter of this book. Until 1893, when His

described the bundle of muscle fibers which is now known by his

name, the transmission of the cardiac stimulus to contraction was

not understood. It has been found, by studying the pathology of

Stokes-Adams disease, as well as by clinically noting with

instruments the contractions of different parts of the heart, that

these slow heart beats are really due to interruptions of the

impulse passing from auricle to ventricle through the bundle of His,

and degeneration in this region is generally the cause of Stokes-

Adams disease. The auricles often beat many times more frequently

than the ventricles, even two or three times as frequently, and, of

course, these auricular contractions are not transmitted to the

arterial system, and the radial pulse notes only the contractions of

the ventricles. The phrase that is used to describe this

nontransmission of the auricular stimulus to the ventricles is

"heart block."



While this disease almost invariably has a pathology, cases have

occurred in which no lesion of the heart could be found, but it

generally occurs coincidently with arteriosclerosis, in which the

coronary arteries are more or less involved and the arterial system

of the brain may be diseased. It occurs more frequently in men than

in women, and in them mostly after middle, or in advanced, life. The

previous history of the patient has often disclosed syphilis. The

intermittence of the pulse may be regular or irregular, and may not

be constant in the early stages of the disease; but when the disease

is established, the rate of the pulse may be reduced to forty,

thirty, or even twenty beats a minute, and it has been known to be

even less. When these intermittences are regular, perhaps two beats

to one intermittence, or three beats to one intermittence are the

most frequent types. When the auricles also beat slowly, perhaps the

vagiare for some reason overstimulated and thus inhibit the heart's

activity.



The attacks of syncope are doubtless due to anemia of the medulla,

because of the infrequent ventricular contractions. This anemia of

the medulla and of the brain may also cause an epileptic seizure, or

a partial paralytic seizure without any apparent paralysis. It is

probable, however, that in these cases there may be coincident

arterial disease in the brain. These sudden syncopal attacks are

likely to occur when a patient suddenly rises from a reclining

posture, especially if he has been asleep. Many persons whose

circulation is none too strong may feel faint on suddenly rising,

but in a person whose pulse is slow and the circulation weak the

danger of causing anemia of the brain by the sudden erect posture is

much increased. Slight faint turns are of frequent occurrence with

these patients; or the faintness may be so rapid and so intense that

the patient may drop in his tracks. Venous pulsation in the neck is

generally marked, showing an impeded contraction of tile right

auricle.



If the auricles are heard or found by instrumental readings to

contract more frequently than the ventricles, the trouble is quite

likely to be a heart block from disease in the heart itself, in the

bundle of His. If the heart is slowed as a whole, the trouble might

be due to diseased arteries or pressure from a growth, a gumma,

perhaps, or other brain tumor in the region of the pons Varolii or

medulla oblongata; or a hemorrhage into the fourth ventricle,

causing pressure, could be the cause.





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