A Case of Myocardial Infarction Associated with Adams-Stokes Syndrome in a 17 year old Girl

• Published in: JAPANESE CIRCULATION JOURNAL Vol. 29; no. 2; pp. 125 - 131
• Main Authors: SAWAKI, MASAMITSU, MAKI, HISASHI, MINATOGAWA, MANABU, MORIWAKI, JUN
• Format: Journal Article
• Language: English
• Published: The Japanese Circulation Society 20-02-1965
• ISSN: 0047-1828; 1347-4839
• DOI: 10.1253/jcj.29.125

Recently, we have experienced a case of juvenile myocardial infarction associated with Adams-Stokes syndrome. Since it is a rare occurence, we like to report the case and discuss the cause which seemed to be due to rheumatic coronary arteritis. A 17-year-old high school girl entered to the Kobe Central Municipal Hospital on September 26th, 1961 because of recurring dizziness and convulsions. On September 22nd, four days before the admission, the patient developed a sore throat and hoarseness of her voice accompanied by a fever of 39°C. The temperature became normal in the morning of 24th after she took some antipyretic medication together with antibiotics. However, the fever reappeared in the evening and continued thereafter. In the morning of 26th, on the admitting day, the patient suddenly developed some uneasiness in her anterior chest soon after she arose. Later on she developed nausea and vomiting and her extremities became clammy. She complained of recurring dizziness and she finally developed convulsions. Upon the entry to the hospital, she was found to be in shocklike state. Her pulse was regular with a rate of 50. Her blood pressure was 102/72 mmHg. Her left tonsil was slightly enlarged and was coated by numerous whitish material of pin-point size. There was neither an enlargement of the heart nor the abnormal heart sounds. Lungs were clear to percussion and auscultation. No organs or masses found in the abdomen. A neurological examination revealed only slightly increased deep tendon reflexes but equal on both sides. There were no pathological reflexes. Upon admitting her to her room, the patient suddenly developed a dizziness and convulsion. During this attack, the pulse was not palpable for about 15 seconds. After an immediate administration of Dihydroxypeopyltheophyllin 0.3g intramuscularly, the patient was kept under an absolute bed rest. Unfortunately, no electrocardiogram was taken during this seizure. She complained of mild chest discomfort for all day. An electrocardiogram on admission, shortly before the seizure, showed a complete A-V block with a rate of 50 per minute. There was right axis deviation and the electrical position of the heart to be vertical. There was also R. B. B. B. The R wave in leads I, aVL and precordial leads from V2 throughout V6 was somewhat low in amplitude. There were some ST elevations in V2 and V3. The second tracing taken 12 hours after the seizure revealed an essentially the same rate, but it now showed left axis deviation and horizontal position of the heart. The procordial leads appeared to be all QS pattern, but a careful examination revealed a small r wave in V1 throughout V6. Leads II, III and aVF demonstrated rS pattern with ST elevations. On September 27th, the 2nd hospital day, another tracing was taken which demonstrated a complete A-V block. The QRS configurations in leads II, III, aVF and V1 through V4 were now QS pattern seemed indicating the presence of L. B. B. B.