Convulsive Syncope Due to Rapid Ventricular Arrhythmias

1. Convulsive syncope due to cerebral anoxia as a result of decreased left ventricular output occurs in ventricular standstill and in rapid ventricular arrhythmias such as tachycardia and fibrillation. Cerebral arteriosclerosis profoundly influences the overall picture.

2. Electrocardiographic study is essential prior to definitive treatment since this is the only certain method by which a distinction can be made between standstill and arrhythmia. Standstill and arrhythmia may occur in the same patient at different times.

3. Myocardial infarction not infrequently causes ventricular arrhythmias.

4. General measures applicable to most patients include oxygen, coronary vasodilators and rest.

5. Uncomplicated ventricular standstill may be treated with epinephrine, but the drug is contraindicated in arrhythmias.

6. Ventricular arrhythmias in the absence of conduction defects may be treated with quinidine or procaine amide. These agents are absolutely contraindicated in the presence of conduction defects because of their tendency to produce ventricular arrhythmias.

7. Isopropyl norepinephrine (Isuprel) is the drug of choice in convulsive syncope. It is not contraindicated in infarctions, hypertension, conduction defects or arrhythmias.