FOUR-YEAR EXPERIENCE WITH AN IMPLANTED CARDIAC PACEMAKER.

BACKGROUND: A 90-year-old woman presented to a hospital emergency department with a brief loss of consciousness that was heralded by spinning vertigo lasting approximately 2 min. She had a long history of intermittent brief episodes of rotatory vertigo, presyncope, and non-vertiginous dizziness, occurring either with or without loss of consciousness. Although initially attributed to symptomatic carotid artery stenosis, these episodes persisted, despite surgical restoration of carotid artery blood flow 1 year after her first syncope. Her medical history was otherwise notable for hypertension, mild depression and a gradual decline in gait and balance function attributed to left hip arthritis and older age. INVESTIGATIONS: Bedside history and examination, non-contrast head CT scan, electrocardiogram, transthoracic echocardiogram, and bedside cardiac telemetry. DIAGNOSIS: Sick sinus syndrome or severe reflex bradycardia with asystole causing recurrent, episodic vertigo, presyncope, non-vertiginous dizziness and syncope (Stokes-Adams attacks). MANAGEMENT: Placement of a temporary pacing wire, followed by surgical implantation of a single-chamber ventricular (VVI) pacemaker.

Adams-Stokes Syndrome↗

PubMed2006

William Osler: slow pulse, stokes-adams disease, and sudden death in families.

In 1903, William Osler, then at Johns Hopkins University, published "On the So-Called Stokes-Adams Disease (Slow Pulse with Syncopal Attacks, etc.)" in The Lancet, classifying a syndrome in evolution. There are thinly disguised references to a brother and to himself in the article, suggesting that Osler was concerned about a family and personal predisposition. Osler's decision to move to Oxford was triggered in part by his personal concerns about cardiac disease. Then, in 1909, Osler contributed a chapter on Stokes-Adams disease to Allbutt and Rolleston's A System of Medicine, complemented by a brilliant pathologic section by the renowned anatomist-morphologist, Arthur Keith. Osler's original contributions involved his emphasis on the importance of family history, his careful clinical and natural history observations, and his recognition of the familial occurrence of bradycardia, Stokes-Adams disease, sudden death, and cardiomyopathy.

Adams-Stokes Syndrome↗