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[Echocardiographic findings in cerebrovascular accidents]
1Institut klinické a experimentální medicíny, Praha.
Insights
Cardiogenic systemic embolism, often from atrial fibrillation, causes 10-20% of strokes. Central nervous system damage can also affect heart function, potentially managed with beta blockers.
Area of Science:
- Cardiology
- Neurology
- Systemic Embolism
Background:
- Cardiogenic systemic embolism accounts for 10-20% of ischemic strokes.
- Atrial fibrillation significantly increases stroke risk (sixfold) compared to sinus rhythm.
- Central nervous system damage can adversely affect cardiac function.
Purpose of the Study:
- To review the frequency and causes of cardiogenic systemic embolism.
- To examine the influence of central nervous system damage on cardiac function.
- To highlight diagnostic advances in identifying cardiac sources of embolism.
Main Methods:
- Review of existing literature on cardiogenic embolism and CNS-cardiac interactions.
- Analysis of echocardiographic findings, particularly transesophageal echocardiography (TEE).
- Discussion of thrombus formation in myocardial infarction and effects of thrombolytic therapy.
Main Results:
- Common cardiac sources of embolism include mitral valve prolapse, patent foramen ovale, and atrial septal aneurysm.
- Cardiac tumors are a rare but significant cause of systemic embolism.
- Spontaneous echo contrast in the left atrium may indicate high thromboembolic risk.
- Cerebral injuries can lead to left ventricular dysfunction.
- High catecholamine levels from CNS damage can cause myocardial injury, preventable with beta blockers.
Conclusions:
- Early identification of cardiac sources is crucial for preventing cardioembolic strokes.
- Transesophageal echocardiography improves detection of subtle cardiac abnormalities.
- Understanding CNS-cardiac interplay is vital for comprehensive patient management.
Abstract:
The authors present a review on the frequency and causes of cardiogenic systemic embolism and on the influence of damage of the central nervous system on the heart muscle. 10-20% of ischaemic cerebrovascular attacks are of cardioembolic origin. In patients with chronic atrial fibrillation the risk of a cerebrovascular attack is six times higher than in the corresponding population with a sinus rhythm. Views on the preventive administration of anticoagulants differ so far. In extensive myocardial infarctions of the anterior wall thrombi in the left ventricle are present in 30-40%. Thrombolytic treatment affects their formation; so far it is not clear whether it reduces the risk of embolization. With technical advances in echocardiography, and in particular transoesophageal echocardiography, attention is focused on abnormal findings in patients with cerebrovascular attacks without manifest heart disease. Most frequently in these patients a prolapse of the mitral valve is found, a foramen ovale patents, an aneurysm of the atrial septum, sometimes thrombi in the left auricula atrialis of an otherwise quite normal heart. A rare finding are cardiac tumours, systemic embolism being frequently their first clinical manifestation. An indicator of high risk of thromboembolism is probably a spontaneous echo contrast in the left atrium, detected reliably only from an oesophageal approach. In the second part the authors summarize contemporary knowledge on the effect of damage of the central nervous system on cardiac action. Cerebral injury or haemorrhage accompany kinetic disorders of the left ventricle of varying impact. Myocardial damage is caused by a high catecholamine level and can be prevented by administration of beta blockers.(ABSTRACT TRUNCATED AT 250 WORDS)