Morganyi-Adams-Stokes's syndrome – a complex of the symptoms caused by sharp decrease in warm emission and ischemia of a brain at the patients suffering from the expressed violations of a rhythm. It is shown in the form of attacks to a syncope, spasms, fibrillation of ventricles, an asistoliya. The diagnosis is established on existence of a characteristic clinical picture, changes on the electrocardiogram, to results of daily monitoring. The disease is differentiated with epilepsy, a fit of hysteria. Treatment consists of resuscitation actions at the time of development of symptomatology and the subsequent therapeutic recovery of normal work of heart.
For the first time Morganyi-Adams-Stokes's syndrome was described by the Italian anatomist and the doctor D. Morganyi in 1761. During the period from 1791 to 1878 the disease was studied by the Irish cardiologists R. Adams and V. Stokes. Taking into account a contribution of all experts the syndrome was called by their names. Pathology is widespread among the patients having cardiac diseases, first of all – blockade of intracardial conductivity and a syndrome of weakness of sinusovy knot. It is more often diagnosed for people 45-55 years are more senior, men make about 60% of total number of patients. The maximum quantity of cases is registered in the developed countries which residents are inclined to a hypodynamia and are subject to influence of cardiotoxic substances. In the states of "the third world" the syndrome meets rather seldom.
Lead congenital organic changes in a structure of the carrying-out system, and also the violations arising under the influence of external pathogenetic factors to development of a disease. Refer overdose to their number antiarrhytmic means (, ), professional intoxication organochlorine connections (vinyl chloride, four-chloride carbon), the dystrophic and ischemic changes of a myocardium affecting large knots of system of automatism (sinatrialny, atrioventricular). Besides, the syndrome can be formed as a result of an age degeneration of the AV-center. Directly the attack has the following reasons:
- Conductivity blockade. The most common etiologichesky form. Develops upon transition of incomplete AV-blockade to full. At the same time there is a dissociation between auricles and ventricles. The first are reduced under the influence of the impulses proceeding from SA-knot, the second are excited by the AV-center or the ektopichesky centers. As also provocative factor partial atrioventricular blockade against the background of a sinusovy rhythm and the increased indicator of warm reductions can serve.
- Violations of a rhythm. The attack comes to light at excessive raising or reduction of ChSS. Usually it is noted to a syncope at patients with the heart rate more than 200 or less 30 beats per minute. In the presence of diffusion defeats of the cerebral vascular device loss of consciousness is observed already at pulse of 40-45 beats/min. Pathology can be also exponentiated by fibrillation of auricles, especially – arisen for the first time. Constant forms seldom lead to emergence of symptomatology of MAS.
- Loss of sokratitelny function. Occurs at ventrikulyarny fibrillation. Muscle fibers of a myocardium are reduced nekoordinirovanno, separately, with very high frequency. It makes blood emission impossible, conducts to a stop of blood circulation and development of clinical death. Can meet at violations of electrolytic balance, have the idiopathic nature (against the background of full health), to be result of influence of physical factors.
Sharp reduction of warm emission which becomes the reason of delay of a blood-groove, insufficient supply of bodies and fabrics blood, oxygen, nutrients is the cornerstone. Originally nervous structures, including a brain suffer from a hypoxia. Work of TsNS is broken, there is a consciousness loss. There are convulsive muscular contractions demonstrating the expressed oxygen starvation of fabrics a bit later. The long attacks which are especially caused by fibrillation of ventricles can lead to post-hypoxemic encephalopathy, polyorgan insufficiency. At preservation of the minimum blood-groove (blockade, arrhythmia) the disease proceeds easier. Attacks in most cases do not lead to the delayed consequences.
The pathogenetic systematization considering the reasons and mechanisms of formation of an attack is used at planned treatment and the choice of measures of prevention. When rendering the emergency help Morganyi-Adams-Stokes's syndrome is more convenient to classify by the form violations of a coronary rhythm as it allows to define optimum tactics of treatment quickly. Distinguish the following types of pathology:
- Adynamic type. It is observed at refusal of sinoatrialny knot, blockade of III and II degrees when the frequency of reductions of ventricles decreases till 20-25. Includes an asistoliya – cardiac arrest arising at sharp and full violation of conductivity of an intracardial impulse. Until connection of alternative ektopichesky zones there passes a lot of time that becomes the blood circulation termination reason.
- Takhiaritmichesky type. Is defined at increase in ChSS to 200 in a minute and above. Comes to light at sinusovy tachycardia, trembling, ventrikulyarny blinking, paroksizmalny supraventrikulyarny shopping malls, fibrillation of auricles with carrying out an impulse on ventricles on roundabout ways at Wolf-Parkinson-Whyte's syndrome.
- The mixed type. The moments of predserdny or ventricular tachycardia alternate with asistoliya episodes. The attack develops at bystry reduction of ChSS from high rates to bradycardia or temporary cardiac arrest. This form is the most difficult for diagnostics and predictively adverse.
The classical attack is characterized by bystry development and a certain sequence of changes. Within 3-5 seconds from the moment of developing of arrhythmia or blockade at the patient the preunconscious state is formed. Suddenly there is dizziness, a headache, a diskoordination, a disorientation, pallor. On skin plentiful cold sweat acts. At palpatorny assessment of pulse sharply expressed tachycardia, bradycardia or an uneven rhythm is found.
The second stage lasts 10-20 seconds. The patient faints. Arterial pressure, a muscular tone decreases. Visually is defined , small clonic spasms develop. At fibrillation of ventricles Goering's symptom – a peculiar hum in the field of a xiphoidal shoot of a breast is noted. In 20-40 seconds of a spasm amplify, get an epileptovidny form, there is an involuntary urination, defecation. If the rhythm is not restored in 1-5 minutes, clinical death with disappearance of pulse, breath, corneal reflexes is observed. The pupil is expanded, HELL is not defined, skin pale, a marble shade.
Perhaps abortive current of an attack with a symptomatology reduction during very short temporary interval. Bark of a brain does not manage to undergo the expressed hypoxia. The main symptoms observed at this option of pathology are dizziness, weakness, passing violation of sight, consciousness obscuring. Manifestations disappear for several seconds without medical intervention. It is extremely difficult to diagnose similar versions MAS as the similar symptomatology comes to light at a set of other states, including at a tserebrovaskulyarny disease.
The syndrome leads to a number of complications, clinical death is basic of which. A long stop of a blood-groove – a factor of dying off of a part of cells of a cerebral cortex. After successful resuscitation it becomes the reason of encephalopathy, somatic violations, decrease in mental capacities of the patient. It is possible to include changes of a psychoemotional background of the patient who is constantly feeling fear of approach of new crisis that negatively affects quality of life, efficiency of work and rest in number of complications. During loss of consciousness and falling on the earth of the patient can get injuries which also carry to the pathological states associated with SMAS.
Primary diagnostics is performed by the employees of SMP who arrived to a call. The final diagnosis is established by the cardiologist, based on results of an electrocardiography and holterovsky monitoring. Differential diagnostics is carried out with an epileptic seizure, hysteria. Distinctive feature of true epilepsy is change of tonic spasms clonic, hyperaemia of the person, the previous aura. At a hysterical origin of pathology of loss of consciousness does not occur, there is a sinusovy warm rhythm. Existence of arrhythmia of this or that character, rapid development of a clinical picture are considered as symptoms of a disease of MAS. In the course of diagnostic search use the following methods:
- Fizikalny inspection. Typical symptoms are noted, the state develops quickly (during several tens seconds). At the anamnesis there are diseases of a cardiological profile, just before an attack the episode of psychoemotional excitement, experiences is possible. HELL it is sharply lowered or it is not measured, a warm rhythm uneven. The type of violation can be determined only by results of the ECG.
- Tool inspection. The main method of hardware diagnostics – an electrocardiography. At the time of emergence of symptoms on a film negative expanded teeth of "T" in assignments of V4-V2 are registered. Presence of the deformed ventricular complexes is possible. At blockade dissociation of "P" with "QRS", a kosoniskhodyashchy depression of a segment of "ST" is observed. Fibrillation is shown by lack of normal activity on the ECG, emergence of the small or large wavy line. By means of daily monitoring it is possible to find passing blockade against the background of which there comes the attack.
- Laboratory inspection. It is carried out for the purpose of definition of etiologies and its consequences. After an episode of clinical death change of the pH level in the sour party, deficiency of electrolytes, presence at myoglobin blood comes to light. At coronary diseases growth of cardiospecific markers is possible: troponina, KFK of MV.
The help at a syndrome of MAS includes direct knocking over of an attack and prevention of a recurrence. At the developing attack saving actions are made by the present health worker irrespective of his profile and specialization. The combined resuscitation actions are carried out. Treatment includes:
- Termination of an attack. The same algorithm is applied that at cardiac arrest. Carrying out prekardialny blow, indirect massage, in the absence of breath – IVL by method of companies in a mouth or with use of the corresponding equipment is recommended. At FZh the electric defibrillation is made. Intravenously adrenaline, atropine, chloride calcium, inotropny means joins. At a takhiaritmiya antiarrhytmic medicines are shown: , .
- Prevention of an attack. If attacks are caused by paroxysms THAT, medicines for stabilization of work of a myocardium and alignment of a warm rhythm are required for the patient. At blockade medicamentous therapy is inefficient, necessary implantation asynchronous or a demand-pacemaker. At retsiprokny tachycardia perhaps expeditious destruction of one of the carrying-out ways of AV-knot.
Forecast and prevention
The forecast favorable at bystry knocking over of an attack and at its abortive option. Normalization of a warm rhythm and blood supply of a brain within 1 minute from the moment of formation of a clinical picture is not followed by the delayed consequences. The long period of an asistoliya or fibrillation of ventricles reduces probability of safe restoration of a coronary rhythm and increases risk of ischemic damage of a brain. Specific measures of prevention are not developed. The general recommendations about prevention of cardiological diseases include refusal of smoking and alcohol, an exception of a hypodynamia, sports, respect for the principles of healthy food. At emergence of the first signs of violations in work of heart it is necessary to see a doctor for inspection and treatment.
1. Morganyi-Adams-Stokes's attack at a syndrome of weakness of sinusovy knot / Batyanov I. S., Bukharova G. V. – 2001.
2. Arrhythmias Heart / Kushakovsky M. S. – 1998.