Early Repolarisation Syndrome and Ischemic Stroke: Is There a Link?

Kallmünzer, Bernd; Kuramatsu, Joji B.; Breuer, Lorenz; Engelhorn, Tobias; Köhrmann, Martin

doi:10.1159/000323611

Cited by 3 publications

(4 citation statements)

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“…Thus, using a pharmacological approach to lower the shivering threshold in awake patients may considerably reduce the need for heavy sedation, paralytics and, therefore, the need for ventilatory support (Guluma et al, 2006). Some pharmacological agents that are used to inhibit shivering include buspirone, meperidine, clonidine, magnesium, and dexmedetomidine (Xue and Huang, 1992; Karibe et al, 1994; Bandschapp and Iaizzo, 2011; Kallmünzer et al, 2011). Several reported pharmacological anti-shivering protocols have allowed investigators to achieve the target temperature (TT) without using heavy sedation or paralytics, often obviating the need for mechanical ventilation (Xue and Huang, 1992; Karibe et al, 1994; Bandschapp and Iaizzo, 2011; Kallmünzer et al, 2011).…”

Section: Pathophysiology Of Hypothermiamentioning

confidence: 99%

“…Some pharmacological agents that are used to inhibit shivering include buspirone, meperidine, clonidine, magnesium, and dexmedetomidine (Xue and Huang, 1992; Karibe et al, 1994; Bandschapp and Iaizzo, 2011; Kallmünzer et al, 2011). Several reported pharmacological anti-shivering protocols have allowed investigators to achieve the target temperature (TT) without using heavy sedation or paralytics, often obviating the need for mechanical ventilation (Xue and Huang, 1992; Karibe et al, 1994; Bandschapp and Iaizzo, 2011; Kallmünzer et al, 2011). In some studies, buspirone and meperidine in combination synergistically decreased the shivering threshold to 33°C, with, notably, minimal sedation or respiratory depression (van Breda et al, 2002; Bandschapp and Iaizzo, 2011).…”

Section: Pathophysiology Of Hypothermiamentioning

confidence: 99%

“…More specifically, in such pharmacological trials, the efficacies of low- and high-dose administration of paracetamol, metamizole, or ibuprofen have been assessed (Dippel et al, 2001, 2003; Koennecke and Leistner, 2001; Kasner et al, 2002; van Breda et al, 2002; Kallmünzer et al, 2011). A pooled analysis showed only a modest reduction of 0.2°C temperature 24 h after administration.…”

Section: Therapeutic Hypothermia In Strokementioning

confidence: 99%

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Therapeutic Hypothermia in Stroke and Traumatic Brain Injury

et al. 2011

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Therapeutic hypothermia (TH) is considered to improve survival with favorable neurological outcome in the case of global cerebral ischemia after cardiac arrest and perinatal asphyxia. The efficacy of hypothermia in acute ischemic stroke (AIS) and traumatic brain injury (TBI), however, is not well studied. Induction of TH typically requires a multimodal approach, including the use of both pharmacological agents and physical techniques. To date, clinical outcomes for patients with either AIS or TBI who received TH have yielded conflicting results; thus, no adequate therapeutic consensus has been reached. Nevertheless, it seems that by determining optimal TH parameters and also appropriate applications, cooling therapy still has the potential to become a valuable neuroprotective intervention. Among the various methods for hypothermia induction, intravascular cooling (IVC) may have the most promise in the awake patient in terms of clinical outcomes. Currently, the IVC method has the capability of more rapid target temperature attainment and more precise control of temperature. However, this technique requires expertise in endovascular surgery that can preclude its application in the field and/or in most emergency settings. It is very likely that combining neuroprotective strategies will yield better outcomes than utilizing a single approach.

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Section: Pathophysiology Of Hypothermiamentioning

confidence: 99%

Section: Pathophysiology Of Hypothermiamentioning

confidence: 99%

Section: Therapeutic Hypothermia In Strokementioning

confidence: 99%

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Therapeutic Hypothermia in Stroke and Traumatic Brain Injury

et al. 2011

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“…1,2 In addition to arrhythmias as a consequence of cardiac comorbidities, neurocardiological interactions and autonomic dysfunction may complicate the course of cerebrovascular disorders. [3][4][5] Therefore, most stroke units are presently equipped with telemetric monitoring, which allows a timely diagnosis and initiation of emergency treatment in serious disturbances of heart rhythm and conduction. 6 However, current guidelines do not give practical advice, in which cardiac monitoring of patients with stroke is of highest importance and how long it should be performed, because data on determinants and time course of arrhythmia onset in the acute phase are scarce.…”

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confidence: 99%

Serious Cardiac Arrhythmias After Stroke

Kallmünzer¹,

Breuer²,

Kahl³

et al. 2012

Stroke

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Background and Purpose-Patients with acute cerebrovascular events are susceptible to serious cardiac arrhythmias, but data on the time course and the determinants of their onset are scarce. Methods-The prospective Stroke-Arrhythmia-Monitoring-Database (SAMBA) assessed cardiac arrhythmias with need for urgent evaluation and treatment in 501 acute neurovascular patients during the first 72 hours after admission to a monitored stroke unit. Arrhythmias were systematically detected by structured processing of telemetric data. Time of arrhythmia onset and predisposing factors were investigated. Results-Significant cardiac arrhythmias occurred in 25.1% of all patients. Incidence was highest during the first 24 hours after admission. Serious arrhythmic tachycardia (ventricular or supraventricular >130 beats/min) was more frequent than bradycardic arrhythmia ( sinus-node dysfunction, bradyarrhythmia, or atrioventricular block °II and °III). Arrhythmias were independently associated with higher age and severer neurological deficits as measured by the National Institutes of Health Stroke Scale on admission. Conclusions-The risk for significant cardiac arrhythmia after an acute cerebrovascular event is highest during the first 24 hours of care and declines with time during the first 3 days. Along with established vascular risk factors, the National Institutes of Health Stroke Scale may be considered for a stratified allocation of monitoring capabilities.

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