Cardioembolic Stroke: Call for a Multidisciplinary Approach

Babarro, Eva González; Rego, Ana Román; González-Juanatey, José Ramón

doi:10.1159/000200444

Cited by 15 publications

(10 citation statements)

References 36 publications

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“…A classification system based on independent risk factors for stroke and used in clinical practice for predicting stroke in patients with non-valvular atrial fibrillation is the CHADS2 index [80] (acronym for Congestive heart failure, Hypertension, Age, Diabetes mellitus and stroke). CHADS2 is formed by assigning 1 point each for the presence of congestive heart failure, hypertension, age 75 years or older, and diabetes mellitus, and by assigning 2 points for history of stroke or transient ischemic attack.…”

Section: Embolic Recurrence In Cardioembolic Infarctionmentioning

confidence: 99%

Cardioembolic Stroke: Clinical Features, Specific Cardiac Disorders and Prognosis

Arboix

Alió²

2010

CCR

366

243

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This article provides the reader with an overview and up-date of clinical features, specific cardiac disorders and prognosis of cardioembolic stroke. Cardioembolic stroke accounts for 14-30% of ischemic strokes and, in general, is a severe condition; patients with cardioembolic infarction are prone to early and long-term stroke recurrence, although recurrences may be preventable by appropriate treatment during the acute phase and strict control at follow-up. Certain clinical features are suggestive of cardioembolic infarction, including sudden onset to maximal deficit, decreased level of consciousness at onset, Wernicke’s aphasia or global aphasia without hemiparesis, a Valsalva manoeuvre at the time of stroke onset, and co-occurrence of cerebral and systemic emboli. Lacunar clinical presentations, a lacunar infarct and especially multiple lacunar infarcts, make cardioembolic origin unlikely. The more common high risk cardioembolic conditions are atrial fibrillation, recent myocardial infarction, mechanical prosthetic valve, dilated myocardiopathy, and mitral rheumatic stenosis. Transthoracic and transesophageal echocardiogram can disclose structural heart diseases. Paroxysmal atrial dysrhyhtmia can be detected by Holter monitoring. In-hospital mortality in cardioembolic stroke (27.3%, in our series) is the highest as compared with other subtypes of cerebral infarction. In our experience, in-hospital mortality in patients with early embolic recurrence (within the first 7 days) was 77%. Patients with alcohol abuse, hypertension, valvular heart disease, nausea and vomiting, and previous cerebral infarction are at increased risk of early recurrent systemic embolization. Secondary prevention with anticoagulants should be started immediately if possible in patients at high risk for recurrent cardioembolic stroke in which contraindications, such as falls, poor compliance, uncontrolled epilepsy or gastrointestinal bleeding are absent.

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Section: Embolic Recurrence In Cardioembolic Infarctionmentioning

confidence: 99%

Cardioembolic Stroke: Clinical Features, Specific Cardiac Disorders and Prognosis

Arboix

Alió²

2010

CCR

366

243

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“…This proportion increases with age. Other common causes of cardioembolic stroke are myocardial infarction (30%), left ventricular thrombus, valve disease or prosthetic valves [134]. …”

Section: Risk Factorsmentioning

confidence: 99%

Epidemiology and Risk Factors of Cerebral Ischemia and Ischemic Heart Diseases: Similarities and Differences

Soler

Ruiz²

2010

CCR

204

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Cerebral ischemia and ischemic heart diseases, common entities nowadays, are the main manifestation of circulatory diseases. Cardiovascular diseases, followed by stroke, represent the leading cause of mortality worldwide. Both entities share risk factors, pathophisiology and etiologic aspects by means of a main common mechanism, atherosclerosis. However, each entity has its own particularities. Ischemic stroke shows a variety of pathogenic mechanisms not present in ischemic heart disease. An ischemic stroke increases the risk of suffering a coronary heart disease, and viceversa. The aim of this chapter is to review data on epidemiology, pathophisiology and risk factors for both entities, considering the differences and similarities that could be found in between them. We discuss traditional risk factors, obtained from epidemiological data, and also some novel ones, such as hyperhomocisteinemia or sleep apnea. We separate risk factors, as clasically, in two groups: nonmodifiables, which includes age, sex, or ethnicity, and modifiables, including hypertension, dyslipidemia or diabetis, in order to discuss the role of each factor in both ischemic events, ischemic stroke and coronary heart disease.

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“…Атеротромботический подтип ИИ на блюдается чаще всего (до 50 % случаев), при этом в 2 / 3 случаев -это атеротромбоз прецеребраль ных и интракраниальных артерий, в 1 / 3 случаев -артериоартериальная эмболия [2]. На 2м по частоте месте находится кардиоэмболический инсульт (20-30 %) [5], наиболее частой причиной которого является фибрилляция предсердий, раз вивающаяся в результате ишемической болезни сердца. Лакунарный инсульт (более 20 % от обще го числа ИИ) возникает при стенозе и тромбозе мелких внутримозговых артерий как следствие артериальной гипертензии, сахарного диабета.…”

Section: патогенетические варианты ишемического онмкunclassified