Stokes-Adams Syndrome

What is Stokes-Adams syndrome?

Stokes-Adams syndrome (also called Adams-Stokes syndrome or cardiac syncope) is a sudden, brief loss of consciousness from a large drop in cardiac output. This happens because of an abnormal heart rhythm and a change in heart rate. You faint because your brain’s not getting enough oxygen-carrying blood.

People with certain heart conditions have an increased risk of Stokes-Adams syndrome, and the syndrome can be life-threatening for some people.

How common is Stokes-Adams syndrome?

About 34% of people age 65 and older who faint do so because of a cardiac cause. Among causes of cardiac syncope, an abnormal heart rhythm is the most common one.

What are the symptoms?

Stokes-Adams syndrome symptoms may include:

• Sudden collapse and loss of consciousness (fainting), especially during exertion or while lying on your back.
• Pale skin when you lose consciousness.
• Flushed skin when you recover from fainting.
• Twitchy or convulsive movement, like a seizure.
• Heart palpitations before fainting.

Healthcare providers call these brief episodes Stokes-Adams attacks. Sometimes, providers mistake Stokes-Adams syndrome for epilepsy because of its seizure-like symptoms.

What causes Stokes-Adams syndrome?

Stokes-Adams syndrome causes include:

• Incomplete or complete atrioventricular heart block.
• Ventricular tachycardia.
• Ventricular fibrillation.
• Bradycardia.
• Paroxysmal ventricular standstill (Having your lower heart chambers stop moving is a rare cause of Stokes-Adams syndrome).

What are the risk factors for Stokes-Adams syndrome?

Risk factors for Adams-Stokes syndrome include:

• Being older than age 60.
• Having bundle branch block.
• Having heart disease.
• Having a family history of heart disease or abnormal heart rhythms.

What are the complications of Stokes-Adams syndrome?

Some of the abnormal heart rhythms that cause Adams-Stokes syndrome can also cause cardiac arrest. People with Stokes-Adams syndrome can hurt themselves when they faint and fall. They may also be in a car accident or miss days of work because of their symptoms.

What are the risks of Stokes-Adams syndrome?

Without treatment, people with Stokes-Adams syndrome are two to four times as likely as the general population to have a vehicle accident. You shouldn’t drive until you’ve talked to your provider, received a pacemaker (if required) and aren’t fainting anymore.

How is Stokes-Adams syndrome diagnosed?

A healthcare provider will ask you about your history of fainting and other medical issues. They’ll also:

• Give you a physical exam to check your heart rate and rhythm.
• Check your blood pressure.
• Order cardiac tests if needed.

What tests will be done to diagnose Stokes-Adams syndrome?

Tests that providers use to make a Stokes-Adams syndrome diagnosis may include:

• Electrocardiogram (EKG).
• Blood tests.
• Tilt table test.
• Electrophysiological study.
• Carotid sinus massage.

How is Stokes-Adams syndrome treated?

A temporary pacemaker can help you with Stokes-Adams syndrome symptoms (if a low or inadequate heart rate caused them) until you can get a permanent pacemaker. A permanent pacemaker:

• Keeps your heart beating in a normal rhythm.
• Keeps your heart from stopping.
• Prevents you from fainting.

Complications/side effects of Stokes-Adams syndrome treatment

Complications from temporary pacemakers may include:

• Device malfunction.
• Infections.
• Heart puncture.

Permanent pacemakers can fail because of batteries running out or parts not working right. A healthcare provider can replace parts in a pacemaker or replace the entire pacemaker.

How long does it take to recover from this treatment?

You should be able to go home from the hospital the same day you receive your pacemaker, or possibly the next day. Depending on your job, you’ll need one week away from work. It takes about four weeks for a complete recovery after receiving a pacemaker.

How can I lower my risk?

Taking care of your heart can help you lower your risk of abnormal heart rhythms that cause Stokes-Adams syndrome. To do this, you can:

• Get regular exercise.
• Eat low-fat and low-salt foods that are good for your heart.
• Lower your stress level.
• Limit the amount of beverages containing alcohol that you drink.
• Avoid the use of tobacco products.
• Get enough sleep each night.

What can I expect if I have Stokes-Adams syndrome?

Stokes-Adams syndrome causes fainting that can be very disruptive to your daily life. It also poses a risk of injury when you pass out and fall down. You’ll need treatment to stop you from having episodes of fainting and/or sudden cardiac death from an abnormal heart rhythm.

Outlook for Stokes-Adams syndrome

If you get a pacemaker, the chance of another Stokes-Adams attack is 5% or lower. It also improves your survival odds. Stokes-Adams syndrome is fatal in 20% to 30% of cases.

How do I take care of myself?

Caring for yourself means managing the heart condition that caused Adams-Stokes syndrome. It also means paying attention to how well your pacemaker is working. Also, be sure to take any medications your provider prescribed for you.

When should I see my healthcare provider?

You should keep all scheduled follow-up appointments with your healthcare provider. This allows them to make sure your pacemaker is working the way it should. Contact your provider between appointments if you’re having trouble with your pacemaker.

What questions should I ask my doctor?

Questions to ask your provider may include:

• How often do you need to see me for pacemaker checkups?
• Are my relatives at risk for abnormal heart rhythms?
• How often will you need to replace my pacemaker or its battery?

A note from Cleveland Clinic

Because the seizure-like symptoms of Stokes-Adams syndrome can make it look like epilepsy, it’s important to have an accurate diagnosis. Don’t be afraid to advocate for yourself if you believe you have a heart condition that’s causing your symptoms. Your provider can talk you through the process of determining which condition you have so you can feel confident with the diagnosis.