Stokes-Adams Syndrome Precipitated by Emotional Stress

This paper presents a psychiatric study of a 28-year-old man with frequent Stokes-Adams episodes in whom demonstrable cardiac pathology is limited to the intermittent conduction abnormalities. Regular psychiatric interviews led the authors to conclude that there was a close connection between the patient's intense unsatisfied dependency strivings and precipitation of his complete heart block. Each Stokes-Adams episode occurring during the interviews was immediately preceded by the expression of intense grief and resentment over disappointed dependency strivings. The theory is advanced that these emotions cause intense vagal stimulation and thus precipitate the heart block. The authors conclude that psychiatric treatment in conjunction with usual medical treatment has a synergistic therapeutic effect by modifying the precipitating emotional disorder.