Cases reported "Adams-Stokes Syndrome"

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1/24. borrelia burgdorferi as a cause of Morgagni-adams-stokes syndrome. Long time follow-up study.

    According the literature atrio-ventricular blockade (AVB) is the most frequent and well-known symptom of Lyme carditis. Typical signs of complete AVB include fatigue, lethargy and syncope- Morgagni-adams-stokes syndrome (MAS). The authors present their results and experience with 5 patients selected from a long-term study (conducted between 1987 and 1998) comprising 58 patients who developed MAS. The authors tried to evaluate the changes especially in the cardiovascular system. They correlated the clinical state with ECG findings, as well as with the levels of the borrelia burgdorferi antibodies. The following results were obtained: 1) all patients had typical syncope, 2) the clinical course was not complicated (except one patient who developed ventricular fibrillation), 3) two patients had frequent symptomatic and asymptomatic arrhythmia including chest pain and episodic rest dyspnea, 4) subjective difficulties (usually palpitations) correlated with ECG findings (Lown 3a, 3b). The authors also looked for any relationship between clinical difficulties and levels of antibodies. The results obtained with an early permanent pacemaker were less favourable than those reported in the literature. Despite early treatment 2 patients had repeated palpitations and ECG correlates during the next years.
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2/24. Complete heart block and systemic lupus erythematosus.

    An 18-year-old girl with systemic lupus erythematosus developed progressive electrocardiographic abnormalities over a period of 16 years, culminating in complete heart block with Adams-Stokes attacks. A permanent ventricular pacing system was implanted successfully.
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3/24. Adams-Stokes seizures due to ventricular tachydysrhythmias in patients with heart block: prevalence and problems of management.

    One hundred and twelve patients with heart block and chronic tendency to syncope were ECG-monitored during syncope. Ventricular tachycardia and/or fibrillation (VT-VF) was observed as the cause of syncope in 11 patients: in 6 of 20 patients with chronic third degree A-V block, in 3 of 65 with paroxysmal A-V block and in 2 of 27 with S-A block. The R-R interval preceding the escape beat which initiated VT-VF varied between 1.2 and 2.2 seconds. The cerebral attacks were amenable to long-term pacemaker treatment. However, relapses of VT-VF were observed during pacing with a low rate of 55 per minute and during short interruptions in pacing, as produced by intermittent pacemaker failure or threshold determination. In one patient, supplementary treatment with a beta-blocking agent had to be given to suppress exercise-induced attacks of VT-VF after pacemaker implantation.
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4/24. A-V block.

    In this report, 61 A-V block patients were analysed using HBE. According to the site of the block, these cases were classified into P(A)-H block, BH block H V block and mixed block. In P(A) H block group (23 cases), the permanent pacemaker implantation was not needed except for one patient with persistent heart failure due to marked bradycardia. Postmortem histology of this patient was well coincident to the results of HBE. In BH block group (18 cases), moderate number of patients were needed to have permanent pacemakers implanted (33%). RA pacing induced split H block with H-V prolongation and varied H and QRS configuration in two cases of this group. These phenomena may be well explained by the longitudinal dissociation theory. In H-V block patients, permanent pacemakers were implanted in all patients (12 cases). In this group, it is difficult to decide the exact location of block, either distal His, bifurcation or bundles, because of the difficulty to record the left or right bundle potentials in clinical practise. Finally, it is important to record the HBE in order to decide the exact site of block, and to choose the suitable therapy for A-V block patients.
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5/24. Acute inflammatory demyelinating polyradiculoneuropathy presenting as complete heart block and Stoke-Adams attacks.

    A patient with acute inflammatory demyelinating polyradiculoneuropathy (AIDP, guillain-barre syndrome) whose presenting complaints were related to autonomic dysfunction in the form of parasympathetic and sympathetic overactivity is reported. Parasympathetic overactivity was severe enough to cause complete atrioventricular block (atropine-responsive) and Stoke-Adams attacks, for which a demand pacemaker was required. Limb weakness was apparent 48 hours later. To our knowledge no such presentation of AIDP has been previously recorded.
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6/24. Long-term ECG monitoring in suspected Adams-Stokes disease.

    Long-term ECG recording techniques have facilitated the diagnosis in atypical cases of Adams-Stockes syndrome. In the use of ambulatory ECG monitoring, new and mainly technical problems have been arisen. In 200 ECG recordings on cassette tape, 78% was considered sufficient for an accurate diagnosis. More than 50% of the unsuccessful recordings were unreadable due to electrode problems. The use of ambulatory monitoring demands that electrode fixation and placement be handled carefully and that the mechanical and electronic equipment be serviced frequently. patients with third-degree atrioventricular block and syncopes of fainting spells run a high risk of sudden death. It is therefore not recommended to use ambulatory monitoring techniques on these patients.
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7/24. Holter monitoring in dizziness and syncope.

    Holter monitoring was used to detect the underlying mechanism among 53 patients referred for dizziness, fainting and/or syncope. The complaints were unexplained on clinical grounds in 38, suggestive of SSS in 11, and of pacemaker dysfunction in 4 patients who underwent pacemaker implantation for symptomatic A-V block. Occult dysrhythmias were revealed in 24 of 38 (61%) of the first group; the clinical impression of SSS was confirmed in 8 of 11 (72%) in the second, and ineffective pacing confirmed in 2 of 4 in the third group. Thus, the diagnosis was clarified in 34 of 53 (64%) of patients. It is concluded that Holter monitoring is most useful for detecting the underlying mechanism in the above mentioned conditions, especially in elderly subjects whose syncopal attacks remained unexplained despite routine cardiological and neurological examination. Holter monitoring should be carried out for at least 36 hours before ruling out dysrhythmias as a cause of dizziness and/or syncopal attacks.
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8/24. Recovery from congenital complete atrioventricular block.

    Congenital complete atrioventricular block without any other intracardiac anomaly reverted to sinus rhythm at the age of 7 years. The girl had had heart failure and Adams-Stokes attacks when aged 1 year, requiring pacemaker implantation. electrocardiography confirmed sinus rhythm for the first time at the age of 7 years. At the same time, a treadmill test yielded a normal tracing without any arrhythmias.
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9/24. Stokes-Adams attacks in congenital complete heart block.

    Stokes-Adams attacks are a well-known complication of congenital complete heart block. Although they are generally felt to be precipitated by either bradycardia or tachycardia, this is poorly documented. A case is presented in which a 23 month old with congenital complete heart block and an intermittently prolonged QT interval had a Stokes-Adams attack during a spontaneous episode of ventricular tachycardia. The combination of congenital complete heart block and a prolonged QT interval carries a significant risk of ventricular tachycardia.
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10/24. Complete heart block in Reiter's syndrome.

    Complete heart block with Stokes-Adams attacks was diagnosed in a 30 year old male, who had suffered from a Reiter's syndrome for only 3 1/2 years. The heart block was unaffected by treatment with high dose corticosteroids, and a permanent pacemaker was implanted. There were no signs of concomitant aortic insufficiency or spondylitis/sacroiliitis.
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