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[Cardiogenic ischemic strokes: pathogenetic aspects]
Insights
This study on acute ischemic stroke patients found that heart rhythm disorders like atrial fibrillation and bradyarrhythmia are key factors. Hemorheological changes and hemostatic activation are also significant in cardiogenic strokes.
Area of Science:
- Cardiology
- Neurology
- Hematology
Context:
- Acute ischemic stroke presents significant challenges in understanding its diverse etiologies.
- Elderly patients (mean age 90.1 years) were studied to explore specific stroke mechanisms.
Purpose:
- To elucidate the role of paroxysmal heart rhythm disorders and silent myocardial ischemia in acute ischemic stroke.
- To determine the pattern of hemorheological changes in cardiogenic strokes.
Summary:
- Eighty-three acute ischemic stroke patients underwent comprehensive evaluation including Holter monitoring and hemorheological assessments.
- Findings revealed paroxysmal atrial fibrillation as significant in embolic cardiogenic stroke.
- Transitory bradyarrhythmia and reduced left-ventricular contractility were identified as key factors in hemodynamic cardiogenic stroke.
- Cardiogenic strokes are linked to plasma hemostasis activation, suggesting targeted hemocorrection.
Impact:
- Highlights the heterogeneity of cardiogenic stroke pathogenesis.
- Emphasizes the diagnostic value of Holter monitoring for detecting paroxysmal arrhythmias.
- Informs targeted therapeutic strategies for cardiogenic stroke management through hemocorrection.
Abstract:
Eighty-three patients with acute ischemic stroke (56 men and 27 women, mean age 90.1 +/- 10.8 years) were examined in order to elucidate the significance of paroxysmal heart rhythm disorders and silent myocardial ischemia and determine the pattern of hemorheological changes. Traditional clinical instrumental examinations were supplemented by Holter monitoring and measurements of a wide spectrum of hemostatic and hemorheological values. Cardiogenic ischemic strokes were pathogenetically heterogeneous. Holter monitoring helped detect the significance of paroxysmal atrial fibrillation in the pathogenesis of embolic cardiogenic stroke. One of the key factors in development of hemodynamic cardiogenic stroke was transitory bradyarrhythmia and deterioration of left-ventricular contractility. Cardiogenic strokes are associated with hemostatic activation with predominant changes in the plasma hemostasis, which dictates purposeful hemocorrection.