Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-5c6d5d7d68-sv6ng Total loading time: 0 Render date: 2024-09-01T03:21:59.058Z Has data issue: false hasContentIssue false

7 - Cardiac diseases relevant to stroke

from Section II - Clinical epidemiology and risk factors

Published online by Cambridge University Press:  05 May 2010

By
Claudia Stöllberger  and
Josef Finsterer
Edited by
Michael Brainin  and
Wolf-Dieter Heiss
Michael Brainin
Affiliation:
Zentrum für Klinische Neurowissenschaften, Donnau-Universität, Krems, Austria
Wolf-Dieter Heiss
Affiliation:
Universität zu Köln
Get access

Summary

Introduction

Cardiac diseases can be relevant to stroke in different respects:

  • In embolic stroke, cardiac diseases may be the cause of embolism, such as atrial fibrillation (AF), endocarditis, left ventricular aneurysm or left ventricular hypertrabeculation/non-compaction (LVHT).

  • Brady- and tachyarrhythmias may compromise cerebral blood flow.

  • Cardiac diseases may coexist, and influence the clinical course and rehabilitation, such as coronary heart disease or dilatative cardiomyopathy (dCMP).

  • In some instances, cardiac diseases may be the consequence of the stroke, such as stroke-induced transient left ventricular dysfunction, also referred to as Takotsubo syndrome (TTS).

  • Congenital abnormalities such as patent foramen ovale (PFO) or atrial septal aneurysm (ASA) may implicate paradoxical embolism.

Several diseases may coexist in a single patient, such as coronary heart disease and AF. Thus, from a pragmatic point of view, this chapter aims to focus on the most frequent and controversially discussed cardiac abnormalities in stroke patients.

Rhythm disturbances

Atrial fibrillation

AF is a cardiac arrhythmia, defined by the absence of P waves and varying RR distances in the electrocardiogram. AF is a common arrhythmia and its prevalence increases with age up to 9% at age 80–89 years (Figure 7.1). Approximately 85% of the individuals with AF are between 65 and 85 years of age [1].

Type
Chapter
Information
Textbook of Stroke Medicine , pp. 105 - 120
Publisher: Cambridge University Press
Print publication year: 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Feinberg, WM, Blackshear, JL, Laupacis, A, et al. Prevalence, age distribution, and gender of patients with atrial fibrillation. Arch Intern Med 1995; 155:469–73.CrossRefGoogle ScholarPubMed
Wolf, PA, Dawber, TR, Thomas, HE, Kannel, WB. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: The Framingham Study. Neurology 1978; 28:973–77.CrossRefGoogle ScholarPubMed
Saxena, R, Lewis, S, Berge, E, et al., for the International Stroke Trial Collaborative Group. Risk of early death and recurrent stroke and effect of heparin in 3169 patients with acute ischemic stroke and atrial fibrillation in the international stroke trial. Stroke 2001; 32:2333–7.CrossRefGoogle ScholarPubMed
Marini, C, Santis, F, Sacco, S, et al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke. Results from a population-based study. Stroke 2005; 36:1115–9.CrossRefGoogle ScholarPubMed
Steger, C, Pratter, A, Martinek-Bregel, M, et al. Stroke patients with atrial fibrillation have a worse prognosis than patients without: data from the Austrian Stroke registry. Eur Heart J 2004; 25:1734–40.CrossRefGoogle ScholarPubMed
Liao, J, Khalid, Z, Scallan, C, et al. Noninvasive cardiac monitoring for detecting paroxysmal atrial fibrillation or flutter after acute ischemic stroke. A systematic review. Stroke 2007; 38:2935–40.CrossRefGoogle ScholarPubMed
Wallmann, D, Tüller, D, Wustmann, K, et al. Frequent atrial premature beats predict paroxysmal atrial fibrillation in stroke patients. An opportunity for a new diagnostic strategy. Stroke 2007; 38:2292–4.Google ScholarPubMed
Douen, AG, Pageau, N, Medic, S. Serial electrocardiographic assessments significantly improve detection of atrial fibrillation 2.6-fold in patients with acute stroke. Stroke 2008; 39:480–2.CrossRefGoogle ScholarPubMed
Spring, M, Dorian, P, Fry, B, et al. A 30-day cardiac event monitor belt for recording paroxysmal atrial fibrillation after a cerebral ischemic event. The EMBRACE Pilot Study. Stroke; 2008; 39:571–2.Google Scholar
Sick, PB, Schuler, G, Hauptmann, KE, et al. Initial worldwide experience with the WATCHMAN left atrial appendage system for stroke prevention in atrial fibrillation. J Am Coll Cardiol 2007; 49:1490–5.CrossRefGoogle ScholarPubMed
Stöllberger, C, Chnupa, P, Kronik, G, et al. Transesophageal echocardiography to assess embolic risk in patients with atrial fibrillation. Ann Intern Med 1998; 128:630–8.CrossRefGoogle ScholarPubMed
Stöllberger, C, Schneider, B, Finsterer, J. Elimination of the left atrial appendage to prevent stroke or embolism? Anatomic, physiologic, and pathophysiologic considerations. Chest 2003; 124:2356–62.CrossRefGoogle ScholarPubMed
Moro, C, Crampes, F, Sengenes, C, et al. Atrial natriuretic peptide contributes to physiological control of lipid mobilization in humans. FASEB J 2004; 18:908–10.CrossRefGoogle ScholarPubMed
Natale, A, Raviele, A, Arentz, T, et al. Venice Chart international consensus document on atrial fibrillation ablation. J Cardiovasc Electrophysiol 2007; 18:560–80.CrossRefGoogle ScholarPubMed
Lee, SH, Tai, CT, Hsieh, MH, et al. Predictors of early and late recurrence of atrial fibrillation after catheter ablation of paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2004; 10:221–6.CrossRefGoogle ScholarPubMed
Hindricks, G, Piorkowski, C, Tanner, H, et al. Perception of atrial fibrillation before and after radiofrequency catheter ablation: relevance of asymptomatic arrhythmia recurrence. Circulation 2005; 112:307–13.CrossRefGoogle ScholarPubMed
Oppenheimer, S. Cerebrogenic cardiac arrhythmias: cortical lateralization and clinical significance. Clin Auton Res 2006; 16:6–11.CrossRefGoogle ScholarPubMed
Topilski, I, Rogowski, O, Rosso, R, et al. The morphology of the QT interval predicts torsade de pointes during acquired bradyarrhythmias. J Am Coll Cardiol 2007; 49:320–8.CrossRefGoogle ScholarPubMed
Tatschl, C, Stöllberger, C, Matz, K, et al. Insular involvement is associated with QT prolongation: ECG abnormalities in patients with acute stroke. Cerebrovasc Dis 2006; 21:47–53.CrossRefGoogle ScholarPubMed
Fure, B, Bruun Wyller, T, Thommessen, B. Electrocardiographic and troponin T changes in acute ischaemic stroke. J Intern Med 2006; 259:592–7.CrossRefGoogle ScholarPubMed
Dhamoon, MS, Tai, W, Boden-Albala, B, et al. Risk of myocardial infarction or vascular death after first ischemic stroke. The Northern Manhattan Study. Stroke 2007; 38:1752–8.CrossRefGoogle ScholarPubMed
Gongora-Rivera, F, Labreuche, J, Jaramillo, A, et al. Autopsy prevalence of coronary atherosclerosis in patients with fatal stroke. Stroke 2007; 38:1203–10.CrossRefGoogle ScholarPubMed
Hankey, GJ, Majrozik, K, Broadhurst, RJ, et al. Five-year survival after first-ever stroke and related prognostic factors in the Perth Community Stroke Study. Stroke 2000; 31:2080–6.CrossRefGoogle ScholarPubMed
Barber, M, Morton, JJ, Macfarlane, PW, et al. Elevated troponin levels are associated with sympathoadrenal activation in acute ischaemic stroke. Cerebrovasc Dis 2007; 23:260–6.CrossRefGoogle ScholarPubMed
Jensen, JK, Kristensen, SR, Bak, S, et al. Frequency and significance of troponin T elevation in acute ischemic stroke. Am J Cardiol 2007; 99:108–12.CrossRefGoogle ScholarPubMed
Finsterer, J, Stöllberger, C, Krugluger, W. Cardiac and noncardiac, particularly neuromuscular, disease with troponin-T positivity. Neth J Med 2007; 65:289–95.Google ScholarPubMed
Vaitkus, PT, Barnathan, EX. Embolic potential, prevention and management of mural thrombus complicating anterior myocardial infarction: a meta-analysis. J Am Coll Cardiol 1993; 22:1004–9.CrossRefGoogle ScholarPubMed
Zielinska, M, Kaczmarek, K, Tylkowski, M. Predictors of left ventricular thrombus formation in acute myocardial infarction treated with successful primary angioplasty with stenting. Am J Med Sci 2008; 335:171–6.CrossRefGoogle ScholarPubMed
Dickerman, SA, Abrutyn, E, Barsic, B, et al. The relationship between the initiation of antimicrobial therapy and the incidence of stroke in infective endocarditis: an analysis from the ICE prospective cohort study (ICE-PCS). Am Heart J 2007; 154:1086–94.CrossRefGoogle Scholar
Cabell, CH, Pond, KK, Peterson, GE, et al. The risk of stroke and death in patients with aortic and mitral valve endocarditis. Am Heart J 2001; 142:75–80.CrossRefGoogle ScholarPubMed
Anderson, DJ, Goldstein, LB, Wilkinson, WE, et al. Stroke location, characterization, severity, and outcome in mitral vs aortic valve endocarditis. Neurology 2003; 61:1341–6.CrossRefGoogle ScholarPubMed
Thuny, F, Avierinos, JF, Tribouilloy, C, et al. Impact of cerebrovascular complications on mortality and neurologic outcome during infective endocarditis: a prospective multicentre study. Eur Heart J 2007; 28:1155–61.CrossRefGoogle ScholarPubMed
Wang, A, Athan, E, Pappas, PA, et al. Contemporary clinical profile and outcome of prosthetic valve endocarditis. JAMA 2007; 297:1354–61.CrossRefGoogle ScholarPubMed
Schulz, R, Werner, GS, Fuchs, JB, et al. Clinical outcome and echocardiographic findings of native and prosthetic valve endocarditis in the 1990s. Eur Heart J 1996; 17:281–8.CrossRefGoogle Scholar
Parrino, PE, Kron, IL, Ross, SD, et al. Does a focal neurologic deficit contraindicate operation in a patient with endocarditis?Ann Thorac Surg 1999; 67:59–64.CrossRefGoogle Scholar
Ruttmann, E, Willeit, J, Ulmer, H, et al. Neurological outcome of septic cardioembolic stroke after infective endocarditis. Stroke 2006; 37:2094–9.CrossRefGoogle ScholarPubMed
Ruel, M, Masters, RG, Rubens, FD, et al. Late incidence and determinants of stroke after aortic and mitral valve replacement. Ann Thorac Surg 2004; 78:77–84.CrossRefGoogle ScholarPubMed
Russo, A, Grigioni, F, Avierinos, JF, et al. Thromboembolic complications after surgical correction of mitral regurgitation. J Am Coll Cardiol 2008; 51:1203–11.CrossRefGoogle ScholarPubMed
Kulik, A, Bédard, P, Lam, BK, et al. Mechanical versus bioprosthetic valve replacement in middle-aged patients. Eur J Cardio-thorac Surg 2006; 30:485–91.CrossRefGoogle ScholarPubMed
Will, MB, Bernacca, GM, Bell, EF, et al. Our inability to predict thromboembolic events after prosthetic valve surgery. J Heart Valve Dis 2006; 15:570–80.Google ScholarPubMed
Cabanes, L, Coste, J, Derumeaux, G, et al. Interobserver and intraobserver variability in detection of patent foramen ovale and atrial septal aneurysm with transesophageal echocardiography. J Am Soc Echocardiogr 2002; 15:441–6.CrossRefGoogle ScholarPubMed
Lechat, P, Mas, JL, Lascault, G, et al. Prevalence of patent foramen ovale in patients with stroke. N Engl J Med 1988; 318:1148–52.CrossRefGoogle ScholarPubMed
Lamy, C, Giannesini, C, Zuber, M, et al. Clinical and imaging findings in cryptogenic stroke patients with and without patent foramen ovale. The PFO-ASA Study. Stroke 2002; 33:706–11.CrossRefGoogle ScholarPubMed
Homma, S, Sacco, RL, Di Tullio, MR, et al., for the PFO in Cryptogenic Stroke Study (PICSS) Investigators. Effect of medical treatment in stroke patients with patent foramen ovale. Patent Foramen Ovale in Cryptogenic Stroke Study. Circulation 2002; 105:2625–31.CrossRefGoogle ScholarPubMed
Schneider, B, Hofmann, T, Justen, MH, et al. Chiari's network: normal anatomic variant or risk factor for arterial embolic events?J Am Coll Cardiol 1995; 26:203–10.CrossRefGoogle ScholarPubMed
Schuchlenz, HW, Saurer, G, Weihs, W, et al. Persisting Eustachian valve in adults: relation to patent foramen ovale and cerebrovascular events. J Am Soc Echocardiogr 2004; 17:231–3.CrossRefGoogle ScholarPubMed
Mas, JL, Arquizan, C, Lamy, C, et al. Patent Foramen Ovale and Atrial Septal Aneurysm Study Group. Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N Engl J Med 2001; 345:1740–6.CrossRefGoogle Scholar
Di Tullio, MR, Sacco, RL, Sciacca, RR, et al. Patent foramen ovale and the risk of ischemic stroke in a multiethnic population. J Am Coll Cardiol 2007; 49:797–802.CrossRefGoogle Scholar
Meissner, I, Khandheria, BK, Heit, JA, et al. Patent foramen ovale: innocent or guilty? Evidence from a prospective population-based study. J Am Coll Cardiol 2006; 47:440–5.CrossRefGoogle ScholarPubMed
Slottow, TL, Steinberg, DH, Waksman, R. Overview of the 2007 Food and Drug Administration Circulatory System Devices Panel meeting on patent foramen ovale closure devices. Circulation 2007; 116:677–82.CrossRefGoogle ScholarPubMed
Stöllberger, C, Finsterer, J, Krexner, E, et al. Stroke and peripheral embolism from an Amplatzer septal occluder 5 years after implantation. J Neurol 2008; 255:1270–1.CrossRefGoogle ScholarPubMed
Burkett, EL, Hershberger, RE. Clinical and genetic issues in familial dilated cardiomyopathy. J Am Coll Cardiol 2005; 45:969–81.CrossRefGoogle ScholarPubMed
Gibelin, P. Anticoagulant treatment and dilated cardiomyopathy. Arch Mal Coeur Vaiss 1995; 88(suppl 4):617–21.Google ScholarPubMed
Crawford, TC, Smith, WT, Velazquez, EJ, et al. Prognostic usefulness of left ventricular thrombus by echocardiography in dilated cardiomyopathy in predicting stroke, transient ischemic attack, and death. Am J Cardiol 2004; 93:500–3.CrossRefGoogle ScholarPubMed
Tribolet de Abreu, TT, Mateus, S, et al. Therapy implications of transthoracic echocardiography in acute ischemic stroke patients. Stroke 2005; 36:1565–6.CrossRefGoogle Scholar
Ikeniwa, C, Sakai, M, Kimura, S, et al. Two cases of Duchenne muscular dystrophy complicated with dilated cardiomyopathy and cerebral infarction. No To Shinkei 2006; 58:250–5.Google ScholarPubMed
McCabe, DJ, Rakhit, RD. Antithrombotic and interventional treatment options in cardioembolic transient ischaemic attack and ischaemic stroke. J Neurol Neurosurg Psychiatry 2007; 78:14–24.CrossRefGoogle ScholarPubMed
Stokman, PJ, Nandra, CS, Asinger, RW. Left ventricular thrombus. Curr Treat Options Cardiovasc Med 2001; 3:515–21.CrossRefGoogle ScholarPubMed
Stöllberger, C, Finsterer, J. Extracardiac medical and neuromuscular implications in restrictive cardiomyopathy. Clin Cardiol 2007; 30:375–80.CrossRefGoogle ScholarPubMed
Artz, G, Wynne, J. Restrictive cardiomyopathy. Curr Treat Options Cardiovasc Med 2000; 2:431–8.CrossRefGoogle ScholarPubMed
Salih, MA, Al-Jarallah, AS, Abdel-Gader, AG, et al. Cardiac diseases as a risk factor for stroke in Saudi children. Saudi Med J 2006; 27(suppl 1):S61–8.Google ScholarPubMed
Hausfater, P, Costedoat-Chalumeau, N, Amoura, Z, et al. AL cardiac amyloidosis and arterial thromboembolic events. Scand J Rheumatol 2005; 34:315–9.CrossRefGoogle ScholarPubMed
Stöllberger, C, Finsterer, J, Schneider, B. Tako-tsubo-like left ventricular dysfunction: clinical presentation, instrumental findings, additional cardiac and non-cardiac diseases and potential pathomechanisms. Minerva Cardioangiol 2005; 53:139–45.Google ScholarPubMed
Abe, Y, Kondo, M, Matsuoka, R, et al. Assessment of clinical features in transient left ventricular apical ballooning. J Am Coll Cardiol 2003; 41:737–42.CrossRefGoogle ScholarPubMed
Gianni, M, Dentali, F, Grandi, AM, et al. Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur Heart J 2006; 27:1523–9.CrossRefGoogle ScholarPubMed
Ueyama, T, Senba, E, Kasamatsu, K, et al. Molecular mechanism of emotional stress-induced and catecholamine-induced heart attack. J Cardiovasc Pharmacol 2003; 41(suppl 1):S115–8.Google ScholarPubMed
Finsterer, J, Stöllberger, C, Sehnal, E, et al. Apical ballooning (Takotsubo syndrome) in mitochondrial disorder during mechanical ventilation. J Cardiovasc Med (Hagerstown) 2007; 8:859–63.CrossRefGoogle ScholarPubMed
Lemke, DM, Hussain, SI, Wolfe, TJ, et al. Takotsubo cardiomyopathy associated with seizures. Neurocrit Care 2008; (in press)
Matsuoka, K, Nakayama, S, Okubo, S, et al. Transient cerebral ischemic attack induced by transient left ventricular apical ballooning. Eur J Intern Med 2004; 15:393–5.CrossRefGoogle ScholarPubMed
Stöllberger, C, Finsterer, J. Left ventricular hypertrabeculation/noncompaction. J Am Soc Echocardiogr 2004; 17:91–100.CrossRefGoogle ScholarPubMed
Stöllberger, C, Winkler-Dworak, M, Blazek, G, et al. Prognosis of left ventricular hypertrabeculation/noncompaction is dependent on cardiac and neuromuscular comorbidity. Int J Cardiol 2007; 121:189–93.CrossRefGoogle ScholarPubMed
Stöllberger, C, Finsterer, J, Blazek, G. Left ventricular hypertrabeculation/noncompaction and association with additional cardiac abnormalities and neuromuscular disorders. Am J Cardiol 2002; 90:899–902.CrossRefGoogle ScholarPubMed
Finsterer, J, Stöllberger, C, Blazek, G. Prevalence of Barth syndrome in adult left ventricular hypertrabeculation /noncompaction. Scand Cardiovasc J 2008; 42:157–60.CrossRefGoogle Scholar
Finsterer, J, Stöllberger, C, Mölzer, G, et al. Cerebrovascular events in adult left ventricular hypertrabeculation/noncompaction with and without myopathy. Int J Cardiol 2007; December 17, Epub.
Schneider, U, Jenni, R, Turina, J, et al. Long-term follow up of patients with endomyocardial fibrosis: effects of surgery. Heart 1998; 79:362–7.CrossRefGoogle Scholar
Sarazin, M, Caumes, E, Cohen, A, et al. Multiple microembolic borderzone brain infarctions and endomyocardial fibrosis in idiopathic hypereosinophilic syndrome and in Schistosoma mansoni infestation. J Neurol Neurosurg Psychiatry 2004; 75:305–7.Google ScholarPubMed
Gautier, JC, Dürr, A, Koussa, S, et al. Paradoxical cerebral embolism with a patent foramen ovale. A report of 29 patients. Cerebrovasc Dis 1991; 1:193–202.CrossRefGoogle Scholar
Stöllberger, C, Slany, J, Schuster, I, et al. The prevalence of deep venous thrombosis in patients with suspected paradoxical embolism. Ann Intern Med 1993; 119:461–5.CrossRefGoogle ScholarPubMed
Ranoux, D, Cohen, A, Cabanes, L, et al. Patent foramen ovale: is stroke due to paradoxical embolism?Stroke 1993; 24:31–4.CrossRefGoogle ScholarPubMed
Itoh, T, Matsumoto, M, Handa, N, et al. Paradoxical embolism as a cause of ischemic stroke of uncertain etiology. A transcranial Doppler sonographic study. Stroke 1994; 25:771–5.CrossRefGoogle ScholarPubMed
Hanna, JP, Sun, JP, Furlan, AJ, et al. Patent foramen ovale and brain infarct. Echocardiographic predictors, recurrence, and prevention. Stroke 1994; 25:782–6.CrossRefGoogle Scholar
Klötzsch, C, Janßen, G, Berlit, P. Transesophageal echocardiography and contrast-TCD in the detection of a patent foramen ovale: experiences with 111 patients. Neurology 1994; 44:1603–6.CrossRefGoogle ScholarPubMed
Rohr-Le Floch, J. Foramen ovale perméable et embolie paradoxale: une hypothèse controversée. Rev Neurol (Paris) 1994; 150:282–5.Google Scholar
Lethen, H, Flachskampf, FA, Schneider, R, et al. Frequency of deep vein thrombosis in patients with patent foramen ovale and ischemic stroke or transient ischemic attack. Am J Cardiol 1997; 80:1066–9.CrossRefGoogle ScholarPubMed
Cramer, SC, Rordorf, G, Maki, JH, et al. Increased pelvic vein thrombi in cryptogenic stroke. Results of the Paradoxical Emboli From Large Veins in Ischemic Stroke (PELVIS) Study. Stroke 2004; 35:46–50.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×