Adams-Stokes syndrome, or Stokes-Adams syndrome, gets its name from the two Irish physicians that first identified it in the 1700s. While it has traditionally been associated with aging and heart disease, it has been identified in people of all ages, including the very young.

What Is Adams-Stokes Syndrome?

Adams-Stokes syndrome describes periodic fainting, called syncope, that is due to slowing of the heart rate. Typically, the person’s heart rhythm will change. This syndrome is often associated with complete heart block. Complete heart block is an abnormal heart rhythm where the top chambers of the heart do not communicate with the bottom chambers. When this happens the bottom chambers beat very slowly. This slow heart rate results in decreased blood flow to the brain. This loss of blood flow to the brain causes a person to faint. 

Some people with Adams-Stokes syndrome can experience frequent episodes. There is usually no specific trigger. The episodes can occur while sitting at a table, lying in bed, or standing in the bathroom brushing their teeth.

Signs and Symptoms

The symptoms can vary for Adam-Stokes syndrome, but many people experience:

  • Lightheadedness
  • Dizziness
  • Pale skin
  • Sweating
  • Twitches
  • Irregular pulse 

These symptoms are often followed by fainting. The loss of consciousness typically lasts seconds but symptoms can last for minutes to hours. Once they recover, the skin may flush red as circulation returns. They wake up as suddenly as they collapse, usually feeling disoriented. 

What is the Cause of Adams-Stokes Syndrome? 

As mentioned above, Adams-Stokes syndrome refers to fainting spells caused by slow heart rhythms, usually complete heart block. Complete heart block may be due to several causes such as low blood flow to the heart, electrolyte abnormalities, hormone problems, and even infections such as Lyme disease. 

How Common is Adams-Stokes Syndrome?

It is relatively common in older adults who are prone to heart disease. It can also occur in younger individuals with an abnormal heart rate. Adams-Stokes syndrome is most common after the age of fifty. However, around 30% of patients experienced their first attack before the age of fifty.

Although it is called a syndrome, it is really a symptom of an underlying heart condition that may or may not be diagnosed. 

How Is It Diagnosed? 

A doctor will diagnose Stokes-Adams syndrome by asking questions about the patient’s medical history and fainting spells. Obtaining an electrocardiogram (ECG or EKG) will show the underlying slow heart rate. Sometimes a patient can wear a heart monitor (Holter monitor) which will monitor a patient's heart rate and heart rhythm over days to weeks. Connecting the person’s slow heart rate or abnormal heart rhythm to the symptoms establishes the diagnosis. 

Treatment Options

The goal is to treat the underlying heart condition to prevent further attacks. The care plan is dependent on the specific heart rhythm abnormality and the underlying cause. Some causes can be easily treated. Electrolyte abnormalities can be managed with supplementation. Hormonal deficiencies can be treated with medications. Low blood flow to the heart may require more complex treatment of blood vessel blockages.  

Implanting a pacemaker can stabilize the heart rhythm and prevent fainting spells. This small device goes under the skin and sends electrical impulses directly to the heart to manage the rate it beats. The heart pacing may be temporary until they can determine and treat the underlying heart problem. It may also be permanent for those who require it. 

Possible Complications

The potential complications from Adams-Stoke syndrome are two-fold. Some complications can occur due to the fainting spell, and there are those associated with the underlying heart condition. Untreated blockages in the blood vessels of the heart can lead to scar of the heart tissue, weakening of the heart muscle, unstable heart rhythms, and sudden cardiac arrest

Since these spells can happen at any time and anywhere, there is a significant safety concern, as well. They may happen while they are driving a car, for example. They may also injure themselves from the fall itself. 

If you experience fainting spells, it is important that you get immediate medical care. Coronary heart disease is the number one cause of death in the United States, and it often goes undiagnosed.