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[Indications for the long-term electrocardiogram and echocardiogram after a cerebral ischemia complication]
J Bonnet1, P Desbordes, J M Orgogozo
1Clinique Médicale Cardiologique, hôpital Cardiologique, Pessac.
Insights
Ambulatory electrocardiographic monitoring (AEM) and echocardiography effectively detect cardiac abnormalities in stroke patients. Echocardiography is best for heart disease or hypertension, while AEM is useful for those with cardiac issues and left heart cavity dilation.
Area of Science:
- Cardiology
- Neurology
- Medical Diagnostics
Context:
- Cerebral ischemic accidents (stroke) without cardiac embolism require thorough cardiac evaluation.
- Standard cardiac evaluation (SCE) may not identify all underlying cardiac causes of stroke.
- Ambulatory electrocardiographic monitoring (AEM) and echocardiography offer advanced diagnostic capabilities.
Purpose:
- To assess the diagnostic yield of AEM and echocardiography in patients with ischemic stroke.
- To determine the optimal use of these investigations based on patient cardiac status.
Summary:
- Ninety stroke patients underwent AEM and echocardiography. Significant arrhythmias were detected by AEM in 10.5% (normal SCE), 18.5% (hypertension), and 33% (heart disease) of patients.
- Echocardiography revealed structural heart disease in 33% (normal SCE), 62% (hypertension), and 91% (heart disease) of patients.
- Arrhythmias correlated with left heart cavity dilation (39%) more than mitral valve prolapse (11%) or hypertrophy (16%).
Impact:
- Findings suggest reserving echocardiography for stroke patients with known heart disease or hypertension.
- AEM is recommended for patients with heart disease or hypertension and left heart cavity dilation.
- This stratified approach optimizes resource allocation for cardiac investigations in stroke patients.
Abstract:
Ninety patients admitted to a neurology unit for cerebral ischaemic accident without evidence of embolism from the heart were examined by ambulatory electrocardiographic monitoring (AEM) and by echocardiography assessable in 76 cases. On the basis of a standard cardiac evaluation (SCE) including physical examination, chest radiography and electrocardiography, the patients were divided into 3 groups: 42 with normal SCE (group I), 19 with isolated arterial hypertension (group II) and 36 with patent cardiac disease (group III). Significant abnormalities were detected by AEM in 10.5% of group I patients, 18.5% of group II patients and 33% of group III patients. A structural cardiopathy was discovered at echocardiography in 33%, 62% and 91% respectively of patients in these 3 groups. The greatest number of mitral valve prolapses (7/9 cases) was found in group I. The main echocardiographic abnormality detected in group II was dilatation of the left cardiac cavities: atrium more than 38 mm in 8 cases, ventricle more than 50 mm in 3 cases. Comparisons between the two explorations showed that arrhythmias were often associated with dilatation of the left cardiac cavities (39%) and much less frequently with mitral valve prolapse (11%) and myocardial hypertrophy (16%). Our results suggest that when examinations cannot be routinely performed in hospital patients with a cerebral ischaemic accident echocardiography should be reserved to patients with heart disease or hypertension, and AEM to those with heart disease or hypertension and with dilatation of the left cardiac cavities.