Adams-Stokes Syndrome Associated With Chronic Heart Block

Friedberg, Charles K.

doi:10.1001/jama.1960.03020110030008

Cited by 38 publications

(11 citation statements)

References 10 publications

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“…Our experience endorses that of others (Caramelli and Tellini, 1960;Friedberg et al, 1960;Dall and Buchanan, 1962;Dall, 1964) who have observed rapid resolution of acute heart block in patients who have had recent myocardial infarction, following intravenous corticosteroid therapy. However, since spontaneous restoration of sinus rhythm is common and sometimes equally rapid under these circumstances, the true effectiveness of corticosteroids is difficult to assess (Penton, Miller, and Levine, 1956;Gilchrist, 1958;Zoob and Shirley Smith, 1963 resolution of the A-V block; and (ii) the likelihood that some patients will still require "pacing" for a short time before sinus rhythm returns (Friedberg et at., 1960).…”

Section: Discussionsupporting

confidence: 89%

“…Sustained resolution of long-standing A-V block in a substantial number of patients in Group IT, though very satisfactory, contrasts sharply with the poor response observed by others when managing this type of clinical problem (Caramelli and Tellini, 1960;Dall and Buchanan, 1962;Dall, 1964). Therefore, a trial with corticotrophin or corticosteroids seems to be worth while in patients disabled with chronic A-V block, not only because there is a reasonable chance of restoring sinus rhythm but also because incapacitating Stokes-Adams syncope can be satisfactorily controlled by this form of treatment, even though A-V conduction is not improved (Aber and Wyn Jones, 1960;Friedberg et al, 1960;Pay and Waverley, 1961;Verel, Mazurkie, and Rahman, 1963). Selection of the most effective " steroid" preparation and the correct dosage remains more speculative.…”

Section: Discussionmentioning

confidence: 88%

“…If, indeed, some form of chronic "inflammatory" reaction was present in complete heart block, it would be reasonable to accept improvement in A-V conduction with corticosteroids and corticotrophin, without having to postulate a "facilitating" effect on nodal activity (Lown et al, 1955). Similarly, it would be easier to understand the return of A-V block on withdrawal of "steroid" therapy in some patients and the critical dependence on maintenance therapy in others (Friedberg et al, 1960;Pay and Waverley, 1961;Verel et al, 1963).…”

Section: Discussionmentioning

confidence: 99%

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Corticotrophin and corticosteroids in the management of acute and chronic heart block.

Aber¹,

Jones²

1965

Heart

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Clinical studies and individual case reports indicate that corticotrophin and corticosteroids frequently help to restore sinus rhythm in acute complete A-V heart block associated with recent myocardial infarction (Prinzmetal and Kennamer, 1954;Phelps and Lindsay, 1957;Aber and Wyn Jones, 1960;Caramelli and Tellini, 1960;Friedberg et al., 1960;Dall and Buchanan, 1962; Dalil, 1964). However, the true value of this form of treatment in chronic A-V block is less certain. Tung, Lu, and Fu (1957) and Litchfield, Manley, and Polak (1958) each reported two patients with long-standing block who reverted to sinus rhythm under corticotrophin therapy, and Pay and Waverley (1961) restored sinus rhythm in 5 out of 6 patients with chronic heart block, using oral corticosteroids. On the other hand, Caramelli and Tellini (1960) failed to improve A-V conduction in 10 patients, and in Dall's series (Dall, 1964) only 2 of the 14 patients with long-standing block regained sinus rhythm while receiving "steroid" therapy.Our experience of corticotrophin and corticosteroids in the treatment of heart block has been less pessimistic. Restoration of sinus rhythm or improved A-V conduction has not only been achieved in most patients with acute heart block, but also in an appreciable number with heart block of considerable duration. SUBJECTS AND METHODSBetween 1958 and 1964 we studied the effects of corticotrophin (ACTH) and corticosteroids on 36 patients with complete A-V block. These patients form 2 groups.Group I: 10 patients (6 men and 4 women) with acute heart block (less than 48 hours' duration) following recent myocardial infarction. The mean age was 60 years (range 43-80 years) and the mean duration of heart block before the start of "steroid" therapy was 16fi5 hours (range 4-48 hours) (Tables I and III). Group II: 26 patients (8 men and 18 women) with chronic heart block (longer than 1 month's duration). Of these, 11 had undoubted coronary artery disease. In the remaining 15 reliable evidence of coronary artery disease was lacking. The mean age was 61 years (range 34-77 years) and the mean duration of heart block in this group was assessed at 8 months (range 5 weeks to 30 months) (Tables II and III). In several patients accurate assessment of the duration of block was not possible; therefore some of the values recorded in Table II may have been underestimated. Selection and Management ofPatients. Corticotrophin or corticosteroids were given to all patients with acute heart block in association with recent myocardial infarction (Group I). Patients with chronic heart block (Group II) were selected for "steroid" therapy if they were experiencing either incapacitating StokesAdams syncope or were in either right or left heart failure and had failed to respond to more conventional treatment.The following criteria determined the initial management of these two groups of patients (Tables I and II). 916

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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Corticotrophin and corticosteroids in the management of acute and chronic heart block.

Aber¹,

Jones²

1965

Heart

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“…Of 15 During the past winter there has been in the clinical wards one case in which the anginal pain was very severe, lasted from an hour to an hour and a half, and recurred every night, generally between two aild four A.M.; besides several others in whom the affection, though present, was less frequent and less severe....…”

Section: Discussionmentioning

confidence: 99%