OVERVIEW

What is Adams-Stokes Syndrome?

Adams-Stokes syndrome, also known as cardiac cerebral ischemic syndrome, is a clinical syndrome caused by sudden changes in heart rhythm that lead to a sharp decrease in cardiac output within a short period, resulting in acute cerebral ischemia. Symptoms include convulsions, loss of consciousness, and syncope, representing a life-threatening condition. Immediate emergency treatment is required, and timely intervention can often save lives.

SYMPTOMS

What are the symptoms and manifestations of Adams-Stokes syndrome?

• The most prominent manifestation of Adams-Stokes syndrome is sudden syncope. In milder cases, dizziness and impaired consciousness may occur, while severe cases can lead to complete loss of consciousness.

• It is often accompanied by convulsions, incontinence, pale complexion, and subsequent cyanosis.

• Sometimes, there may be snoring sounds and gasping respiration, or Cheyne-Stokes respiration—a pattern where breathing transitions from shallow and slow to deep and rapid, then back to shallow and slow, followed by a period of apnea before repeating the cycle.

• The pulse may become undetectable, heart sounds may be absent, or the heart rate may be extremely rapid with faint heart sounds.

Why does Adams-Stokes syndrome cause syncope?

In Adams-Stokes syndrome, a sharp decline in cardiac output leads to a sudden reduction in cerebral blood supply, resulting in syncope.

CAUSES

Under what circumstances is Adams-Stokes syndrome prone to occur?

Any condition that causes a sharp decrease in cardiac output within a short period can trigger Adams-Stokes syndrome. For example:

• Compression of the carotid sinus, stimulating increased vagal tone, leading to atrioventricular block;

• Organic heart diseases such as coronary heart disease and valvular disease;

• Arrhythmias, drug side effects, infections, electrolyte and acid-base imbalances;

• Congenital heart disease, mechanical failure of artificial pacemakers;

• Tumors, tuberculosis, parasites, or purulent lesions near the ventricular septum.

DIAGNOSIS

What tests are needed for Adams-Stokes syndrome?

• Electrocardiogram (ECG) is the most basic test, which can identify the nature of arrhythmias.

• 24-hour Holter monitoring can detect certain related arrhythmias and help determine the relationship between the timing of arrhythmias and symptoms.

• Cardiac electrophysiological studies may also be performed if necessary.

• Electrolyte and blood gas analysis can help assess electrolyte imbalances and acid-base disturbances.

• During the interictal period, echocardiography can be performed to help rule out conditions that obstruct cardiac output and congenital heart diseases.

What diseases share similar symptoms with Adams-Stokes syndrome?

The most typical symptoms of Adams-Stokes syndrome are sudden syncope and loss of consciousness. Therefore, it must be differentiated from all conditions that can cause syncope, such as cerebral hemorrhage, transient ischemic attack (TIA), vasovagal syncope, hypoglycemia, orthostatic hypotension, epilepsy, hysteria, migraine, chronic lead poisoning encephalopathy, hyperventilation syndrome, and severe anemia.

Blood tests, ECG, cardiac ultrasound, head CT, head MRI, and electroencephalography (EEG) can help differentiate these conditions from Adams-Stokes syndrome.

TREATMENT

Which department should I visit for Adams-Stokes syndrome?

The main symptom of Adams-Stokes syndrome is sudden syncope. After sudden fainting, the patient should be immediately sent to the emergency department. Once stabilized, further examination and treatment can be conducted in the cardiovascular medicine department.

How is Adams-Stokes syndrome treated?

• Quickly check for pulse and breathing. If absent, perform emergency resuscitation immediately. Lay the patient flat on a firm surface and begin CPR.

• For bradycardia, medications like atropine or isoproterenol can be used to increase heart rate, or a pacemaker may be implanted.

• For tachycardia, antiarrhythmic drugs such as lidocaine, propafenone, or amiodarone may be administered, with electrical cardioversion if necessary.

• Correct fluid, electrolyte, and acid-base imbalances.

• For acute cardiac obstruction (e.g., congenital heart disease, cardiac tumors), surgical intervention should be performed as early as possible if indicated.

Does Adams-Stokes syndrome require hospitalization?

Adams-Stokes syndrome is a critical emergency that can lead to sudden death in severe cases. Hospitalization is mandatory for strict vital sign monitoring and medical support.

What are the consequences of untreated Adams-Stokes syndrome?

Failure to restore cerebral blood flow promptly can cause severe brain hypoxia, energy depletion, and accumulation of harmful metabolites like lactic acid, leading to neurological damage or even death.

What is the likelihood of death from Adams-Stokes syndrome?

The most common cause of death in Adams-Stokes syndrome is cardiac arrest. In China, the survival rate after cardiac arrest is extremely low, with a mortality rate exceeding 98%.

How is improvement measured after treatment for Adams-Stokes syndrome?

ECG and cardiac monitoring will show restored normal rhythm, with the patient’s complexion improving, breathing stabilizing, and consciousness returning.

However, after systemic ischemic injury, patients may enter a more complex phase of ischemia-reperfusion injury depending on the duration of ischemia, requiring continued aggressive treatment.

DIET & LIFESTYLE

What should patients with Adams-Stokes syndrome pay attention to in daily life?

• Actively cooperate with doctors in treating the underlying disease to prevent recurrence of Adams-Stokes syndrome.

• Avoid prolonged standing or suddenly standing up after prolonged sitting/lying down; avoid strenuous exercise.

• When feeling faint, immediately sit, squat, or lie down to prevent fall injuries.

What should patients with Adams-Stokes syndrome pay attention to in their diet?

Dietary adjustments should be determined based on the underlying disease causing Adams-Stokes syndrome. You can directly search for related diseases in the App to learn more about dietary precautions.

PREVENTION

How to Prevent Adams-Stokes Syndrome?

Most cases of Adams-Stokes syndrome are related to various heart diseases. Actively treating the underlying heart condition can help prevent its occurrence.

For healthy individuals, maintaining a healthy lifestyle is sufficient:

• Follow a diet low in salt, fat, and sugar;
• Avoid smoking and limit alcohol intake;
• Exercise regularly, avoid prolonged sitting, and prevent overweight or obesity. Aim for 3–5 sessions per week, about 30 minutes each, combining aerobic and strength training at a moderate intensity without overexertion;
• Learn to manage stress and emotional tension effectively.