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[Patients with transient ischemic attacks. Their cardiac status and its prognostic significance]
C Spielberg1, I Kruck, E R von Leitner
1Abteilung für Kardiopulmologie, Freie Universität Berlin.
Insights
Routine exercise ECGs are recommended for patients experiencing transient ischemic attacks due to high rates of undiagnosed coronary heart disease. However, 24-hour ECG monitoring is not essential for these patients.
Area of Science:
- Cardiology
- Neurology
Context:
- Transient ischemic attacks (TIAs) are often associated with underlying cardiovascular conditions.
- Echocardiography and electrocardiography are used to assess cardiac function and rhythm in patients with neurological events.
Purpose:
- To investigate the correlation between echocardiographic findings, arrhythmias, and coronary heart disease with recurrent cerebral ischemia in patients with acute transitory cerebral ischemia.
Summary:
- 51 patients with acute transitory cerebral ischemia underwent echocardiograms, 24-hour ECGs, and exercise ECGs.
- Abnormal echocardiograms were found in 58% of patients; mitral valve prolapse was noted in eight patients, with five experiencing recurrent ischemia.
- Half of the patients had coronary heart disease, identified through resting and exercise ECGs. Recurrent cerebral ischemia occurred in 13 patients, and four died, all with coronary heart disease.
Impact:
- Routine exercise ECGs are recommended for patients with transient ischemic attacks, protracted ischemic neurological deficit, or "minimal stroke" due to the high prevalence of undiagnosed coronary heart disease.
- 24-hour ECG monitoring appears non-essential for this patient group.
- Further randomized trials are necessary to evaluate prophylactic treatment for patients with cerebral ischemia and echocardiographic evidence of mitral valve prolapse.
Abstract:
In 51 consecutive patients with acute transitory cerebral ischaemia cross-sectional echocardiograms, 24-hour electrocardiograms (ECG) and exercise ECGs were recorded. The subsequent observation period averaged 13 (3-30) months. The echocardiogram was abnormal in 27 of 46 patients (58%). A holosystolic mitral-valve prolapse was found in eight: cerebral ischaemia recurred in five. There was no correlation between arrhythmias in the 24-hour ECG and renewed cerebral ischaemia. In addition to the 14 patients who--according to history and resting ECG--had already had a myocardial infarction, the exercise ECG revealed probably coronary heart disease in a further 11, i.e. half of the patients had coronary heart disease. Renewed attacks of cerebral ischaemia occurred in 13 patients during the follow-up period; four patients died, all of them also having had coronary heart disease. Because of the high prevalence of coronary heart disease (often previously undiagnosed) in the whole group, routine exercise ECGs are recommended for patients with transitory ischaemic attacks, protracted ischaemic neurological deficit or "minimal stroke", while 24-hour ECG monitoring does not seem essential. Randomized trials are needed to determine whether patients with cerebral ischaemia and echocardiographic evidence of mitral-valve prolapse should be treated prophylactically.