FAINTING AND FITS IN CARDIAC INFARCTION

Abstract

Among 200 patients with acute cardiac infarction, a syncopal or epileptiform attack was observed in 15. At the onset, syncope occurred in 10, of whom 5 were 70 or more in age. The patients presented the picture of severe peripheral circulatory failure, often combined with slow heart rate. In one patient, there was ventricular tachycardia. Pain was often absent or slight. Posterior infarction was commoner than anterior. Syncope and fits in the course of cardiac infarction are reported in 5 patients whose avg. age was 69. Two had suffered previously from anginal pain, 2 had syncope, and 3 had Stokes-Adams attacks. All 5 died within 29 days of the onset of infarction. Abnormal rhythms were recorded in 4 cases. The principal factor in the production of the syncopal or epileptiform attack must be a nervous reflex leading to vasomotor depression and vagal stimulation causing bradycardia. A subsidiary effect is the reduced force of systole resulting from the infarction. Another factor to be considered is the age of the patient. This, when it reduces the elasticity of the vascular tree and when it is accompanied by degenerative vascular changes in the brain, may sensitize the cerebrum to any reduction in blood flow. No patient with syncope or similar seizures or Stokes-Adams attacks survived for many days, indicating a serious prognosis.