THE ELECTROCARDIOGRAM OF THE STOKES-ADAMS ATTACK

Abstract

rhe combination of a slow pulse with syncopal, epileptiform, or pseudo-apoplectic attacks was briefly mentioned by Morgagni in 1761; then it was more fully described by an Edinburgh physician, Spens (1793), and by Adams (1827) and Burnett (1827), equally well in the same year. Mayo (1838), reviewing examples of slowness of the pulse and quoting Spens, included one such case; and Holberton (1841) added another. Stokes (1846) wrote the important paper that drew general attention to the subject: because of this, and because Huchard (1899) originally proposed the term Stokes-Adams disease, we strongly favour its retention in this order and excluding the use of the word " syndrome ", which would imply that all similar cases whatever the underlying pathology were to be included. Shortly after Stokes's publication, the discovery was made of the slowing effect on the heart of vagal stimulation, and this governed the views on brady-cardia until the end of the last century. Since 1900, with development of our knowledge of heart block, the newer conception placed bradycardia in general as due to an intrinsic myocardial lesion and seldom to a vagal effect. But from this division into neurogenic and myocardial causes another difficulty arises when we consider the definition of Stokes-Adams disease to-day. As our knowledge of the disease is infinitely greater, there is need to define it afresh. Shall it include all cases of cardiac syncope whether these result from vagal action or from ventricular asystole of myocardial origin? We think not, believing that heart block of some grade should be present at some time if the term Stokes-Adams attack is to retain a distinctive meaning. Our reasons are that the great majority of the clinical cases in question are due to myocardial disease with block and that their course, prognosis, and treatment are similar; whereas the reported cases of neurogenic origin (usually without block) are rare and of varied etiology and prognosis, and may reasonably be classified as cardiac syncope. Definition.-Stokes-Adams disease is a name applicable to patients with heart block who suffer from recurrent attacks of loss of consciousness due to ventricular standstill, ventricular tachycardia, ventricular fibrillation, or a com-bination of these. During a Stokes-Adams attack from ventricular standstill the auricle con-tinues to beat, whereas in other cardiac syncopes as a rule there is total cardiac standstill.