Sindrome di Adams-Stokes
Table of Contents
Definizione
La sindrome di Adams-Stokes è caratterizzata da lipotimia o sincope, dovute a disturbi dell’irrorazione cerebrale, in pazienti con polso lento o accessi di tachicardia, spesso ventricolare. Nella sindrome di Adams-Stokes l’attacco si verifica senza preavviso, con conseguente improvvisa perdita di coscienza.
Fisiopatologia
La sincope è dovuta ad un’ ischemia cerebrale che può comparire nelle circostanze seguenti:
- Lunga pausa ventricolare durante un blocco atrio-ventricolare completo.
- Passaggio da ritmo sinusale a blocco atrio-ventricolare con ripresa tardiva del ritmo idioventricolare. Trasformazione di un blocco atrio-ventricolare incompleto in blocco atrio-ventricolare completo.
- Crisi di tachicardia di qualunque origine, ma di preferenza ventricolare, in soggetti che abbiano già un irrorazione cerebrale compromessa. Talvolta la pausa ventricolare che segue la tachicardia è la causa della sincope.
- Sindrome di brachicardia-bradicardia.
Sintomi
- Sincope:improvvisa. Il paziente cade senza conoscenza, pallido, cianotico. La perdita di coscienza dura da qualche secondo a 1-2 minuti o più. Può accompagnarsi a una crisi convulsiva generalizzata. Il respiro è rallentato. Il polso non percepibile durante la sincope, ricompare; il malato rinviene e può riprendere rapidamente le sue attività precedenti. Non vi è periodo post-critico come nell’epilessia, né malessere o stato di nausea residuo, come nella sincope vaso-vagale.
- Polso: alcuni pazienti hanno un polso molto lento durante le sincopi, intorno a 30 pulsazioni/minuto;altri non hanno polso percepibile.Fra le perdite di conoscenza, l’ECG può non presentare alcun disturbo di conduzione o al contrario mettere in evidenza disturbi diversi nella conduzione atrio-ventricolare.
Diagnosi
Si basa sull’ECG semplice, registrato durante una sincope, o sulla registrazione continua dell’ECG per 24 o più ore ( Holter). Questo deve essere talvolta ripetuto più volte fino a che si registra una sincope tipica. La sindrome di Adams-Stokes pone la diagnosi differenziale delle sincopi. Poiché colpisce soprattutto soggetti anziani, la diagnosi differenziale più frequente è quella di ischemia cerebrale transitoria, riconoscibile per la presenza di disturbi neurologici di localizzazione che accompagnano la sincope.
Trattamento
Il trattamento iniziale può essere medico e prevede l’uso di farmaci come l’isoprenalina e l’epinefrina (adrenalina).Trattamento definitivo è chirurgico e prevede l’inserimento di un pacemaker.
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