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[Cardiac pacemaker therapy for optimizing brain circulation. A possible prevention for cerebrovascular diseases?]
A Hagendorff1, C Dettmers, W Jung
1Medizinische Universitätsklinik und Poliklinik, Leipzig. hagendorff@gmx.net
Deutsche Medizinische Wochenschrift (1946)
|April 1, 2000
Summary
Pacemaker therapy can effectively treat cognitive impairment and dizziness caused by reduced cardiac output and cerebral blood flow in patients with impaired cerebral autoregulation.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- A 78-year-old patient presented with dizziness, cognitive decline, fatigue, and syncope.
- Pre-existing conditions included hypertensive heart disease, reduced left ventricular function, and ventricular ectopia (Lown IVb).
Observation:
- Cerebral blood flow autoregulation appeared impaired, with a correlation between cardiac output and cerebral blood flow.
- Computed tomography revealed minimal cerebral atrophy, with no evidence of arterial stenosis or intracranial disease.
Findings:
- Permanent pacemaker implantation resolved the patient's symptoms, improving cognitive function and eliminating syncope.
- Recurrence of symptoms during atrial fibrillation (120/min) was linked to decreased cardiac output (4.0 L/min) and cerebral blood flow (35 mL/100 g/min).
- Restoration of sinus rhythm led to increased cardiac output and cerebral blood flow, resolving symptoms.
Implications:
- Reduced cardiac function and output can significantly impair cerebral blood flow in patients with compromised cerebral autoregulation.
- This impairment can manifest as cognitive deficits and neurological symptoms.
- Pacemaker therapy presents a viable therapeutic option for managing such conditions.