Auriculoventricular dissociation and the Adams-Stokes syndrome in acute coronary vessel closure

Abstract

1. 1. A study was made of fifteen patients exhibiting the Adams-Stokes syndrome following an acute coronary vessel closure. This group formed one-third of a series of forty-five patients with the Adams-Stokes syndrome seen during a period of four years. There were thirteen males and two females, the youngest being fifty-three years of age and the oldest seventy-one years. In each instance there was evidence of antecedent hypertension, and six patients showed signs of congestive heart failure prior to the present symptoms. 2. 2. Of the fifteen patients, four died within an average of four days, the rhythm returning to normal in two. Seven lived for an average of twenty-six months, with either transient or complete auriculoventricular dissociation alternating during that time. Four are still living with normal sinus rhythm. 3. 3. A permanent drop in the blood pressure after the establishment of a basic rhythm following the acute coronary vessel closure was the most persistent sign of the presence of that lesion. 4. 4. The immediate treatment of such patients consists in the application of warmth to the body to overcome the initial shock and the repeated intramuscular injections of epinephrine hydrochloride until the block is either lifted with a return of normal sinus rhythm, or else a relatively fixed basic ventricular rhythm is established in the presence of auriculoventricular dissociation. 5. 5. The after-care of those patients who still show auriculoventricular dissociation must include the daily administration of ephedrine sulphate to prevent a slowing of the basic ventricular rate. According to the results obtained, neither of these drugs is contraindicated in patients with acute coronary vessel closure in whom the circulation to the auriculoventricular node is involved. 6. 6. Since the auriculoventricular node is in the upper part of the interventricular septum and is supplied by an arterial system in the posterior part of the heart, it may be concluded that patients with complete heart-block and Adams-Stokes syndrome as a result of an acute coronary vessel closure have an infarct in the posterior wall of the left ventricle and the adjacent septum. 7. 7. The electrocardiographic pattern of infarction of the ventricle does not hold true for patients with auriculoventricular dissociation, for, in most of our instances, the electrocardiogram showed intraventricular conduction disturbance. 8. 8. Since, of the fifteen patients with complete heart-block and Adams-Stokes syndrome who survived the acute coronary vessel closure, seven lived an average of twenty-six months; it appears that the prognosis for such patients, as far as longevity is concerned, is not bad.