Myocardial stress in patients with acute cerebrovascular events
Christian M Jespersen1, Jørgen Fischer Hansen
1Global Development, Novo Nordisk, Bagsvaerd, Denmark. crmj@novonordisk.com
Insights
Cardiac changes are frequent after acute cerebrovascular events, often mimicking myocardial infarction. These reversible signs are typically due to catecholamine release, not coronary thrombosis, but warrant cardiac follow-up.
Area of Science:
- Cardiology
- Neurology
- Internal Medicine
Background:
- Myocardial involvement is frequently observed in patients experiencing acute cerebrovascular events.
- Common cardiac signs include ST segment deviations, impaired left ventricular function, elevated N-terminal pro-brain natriuretic peptide (NT-proBNP), prolonged QT interval, and increased troponins, affecting up to one-third of patients.
Purpose of the Study:
- To investigate the nature and implications of myocardial involvement following acute cerebrovascular events.
- To differentiate cardiac changes secondary to cerebrovascular events from actual coronary thrombosis.
Main Methods:
- Review of literature on cardiac manifestations in acute cerebrovascular events.
- Analysis of reported cardiac findings such as electrocardiographic changes, ventricular function, and biomarker levels (NT-proBNP, troponins).
Main Results:
- Cardiac abnormalities are common, occurring in up to one-third of patients with acute cerebrovascular events.
- The majority of these cardiac findings are reversible.
- These changes can mimic myocardial infarction but are often attributed to acute catecholamine release triggered by the cerebrovascular event, rather than coronary thrombosis.
Conclusions:
- Cardiac signs during acute cerebrovascular events are frequently reversible and may result from catecholamine surge.
- While these signs can resemble myocardial infarction, they are not necessarily indicative of coronary thrombosis.
- A cardiological follow-up is essential for all patients with cardiac involvement during acute cerebrovascular events to rule out coexisting ischemic heart disease.
Abstract:
Signs of myocardial involvement are common in patients with acute cerebrovascular events. ST segment deviations, abnormal left ventricular function, increased N-terminal pro-brain natriuretic peptide (NT-proBNP), prolonged QT interval, and/or raised troponins are observed in up to one third of the patients. The huge majority of these findings are fully reversible. The changes may mimic myocardial infarction, but are not necessarily identical to coronary thrombosis. Based on the literature these signs may represent an acute catecholamine release provoked by the cerebrovascular catastrophe itself and not coronary thrombosis. However, all patients with signs of cardiac involvement during acute cerebrovascular events should receive a cardiological follow-up in order to exclude concomitant ischemic heart disease.
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