A patient with bradycardia may suffer syncope in the form of a Stokes-Adams attack.


Features of a Stokes-Adams attack:

(1) The patient has a syncopal episode that has a sudden onset and typically a short duration.

(2) The episode is immediately preceded by total loss of skin color, with the patient becoming very pale.

(3) Recovery from the episode is associated with flushing of the skin.


The attack may be caused by a cardiac arrhythmia, usually one causing transient bradycardia such as bundle branch block.


The diagnosis can be suspected by the clinical description, especially if the pulse is noted to be very slow during an episode. Demonstrating the arrhythmia during an attack (for example with a Holter monitor) is diagnostic.


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