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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors studied 101 patients with a combination of acute disorders of brain circulation and changes in the rhythm of heart activity in the form of sinus tachycardia, extra-systolia, fluttering arythmia. In ischemic strokes fluttering arythmia was encountered quite frequently while as in hemmorhages it was almost never seen. In 20 cases disorders of heart rhythm appeared following several days or more after the stroke. These data permit to assume that disorders of rhythm in the heart activity may be one of the pathogenetical factors of acute disorders of brain circulation. Their appearance after strokes is most frequently associated with signs of acute or exacerbated coronary insufficiency. Flutter arythmia in patients with strokes should be taken into consideration indifferential diagnosis of brain haemmorhages and infarctions.
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PMID:[Heart rhythm disorders in acute cerebral circulatory disorders]. 6 80

Atrial fibrillation and atrial flutter are common arrhythmias after coronary artery bypass grafting. Although the consequences of the arrhythmia are generally not life-threatening, it constitutes a major clinical problem often requiring conversion to sinus rhythm. Atrial fibrillation or flutter can result in hypotension, heart failure, pneumonia, and stroke. This article reviews the literature on epidemiology, electrophysiology, risk factors, and preventive trials. The major conclusions are: (1) In patients undergoing coronary artery bypass surgery, the incidence of postoperative atrial fibrillation or flutter is 20-30%, the peak incidence being on the second or third postoperative day. (2) The strongest independent preoperative predictor for atrial fibrillation or flutter is the patients' age. (3) Intra-atrial conduction delay recorded pre and peroperatively may predict development of atrial fibrillation. (4) Peroperative inducibility of atrial fibrillation by pacing the right atrium may identify patients at risk for postoperative atrial fibrillation. (5) Development of postoperative atrial fibrillation or flutter has not been associated with peroperative or postoperative events. (6) The specificity and sensitivity of age and other possible relevant factors for prediction of atrial fibrillation or flutter after coronary artery bypass grafting is low. (7) No effective prophylactic regimen has yet been established.
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PMID:Atrial fibrillation and flutter after coronary artery bypass surgery: epidemiology, risk factors and preventive trials. 135 29

The hemodynamic background associated with the occurrence of paroxysmal atrial fibrillation and flutter (PAF), in patient with acute myocardial infarction (AMI) were evaluated. Sixty-seven of 381 consecutive AMI patients (17.6%) were noted to have PAF in the acute phase of infarction. These 67 patients with PAF (group 1) were compared with 60 randomly selected patients without PAF (group 2). The hospital mortality rate was 25.4% in group 1, and 11.7% in group 2 (p less than 0.01). The hemodynamic variables measured before the onset of PAF in group 1, showed significantly more unfavorable values than those in group 2, which were measured at the time of admission. The 67 patients in group 1 were divided into 50 patients who survived (group S) and 17 patients who died in the hospital (group D). The hemodynamic status in group D demonstrated significantly larger deterioration before the onset of PAF than in group S. Hemodynamic variables were compared before and during PAF in groups D and S, cardiac index (CI) decreased significantly, and stroke index (SI) decreased by 46% in group D, with no decrease in CI and less decrease in SI (28. p less than 0.05) in group S. In conclusion, not only the occurrence of PAF, but the prognosis of patients with PAF is dependent on the severity of hemodynamic disturbance imposed by AMI. Atrial contribution to ventricular filling has great importance in the maintenance of the cardiac output in this patient population.
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PMID:Paroxysmal atrial fibrillation and flutter associated with acute myocardial infarction: hemodynamic evaluation in relation to the development of arrhythmias and prognosis. 153 70

The need for prophylactic anticoagulation to prevent embolism before direct current cardioversion is performed for atrial fibrillation or atrial flutter is controversial. To examine this issue further, a retrospective review was undertaken to assess the incidence of embolic complications after cardioversion. The review involved 454 elective direct current cardioversions performed for atrial fibrillation or atrial flutter over a 7 year period. The incidence rate of embolic complications was 1.32% (six patients); the complications ranged from minor visual disturbances to a fatal cerebrovascular event. All six patients had atrial fibrillation, and none had been on anticoagulant therapy (p = 0.026). The duration of atrial fibrillation was less than 1 week in five of the six patients who had embolic complications. Baseline characteristics of patients with a postcardioversion embolic event are compared with those of patients who did not have an embolic event. There was no difference in the prevalence of hypertension, diabetes mellitus or prior stroke between the two groups, and there was no difference in the number of patients who were postoperative or had poor left ventricular function. Left atrial size was similar between the two groups. No patient in the embolic group had valvular disease. No patient with atrial flutter had an embolic event regardless of anticoagulant status; therefore, anticoagulation is not recommended for patients with atrial flutter undergoing cardioversion. Prophylactic anticoagulation is pivotal in patients undergoing elective direct current cardioversion for atrial fibrillation, even those with atrial fibrillation of less than 1 week's duration.
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PMID:Role of prophylactic anticoagulation for direct current cardioversion in patients with atrial fibrillation or atrial flutter. 154 82

To examine the relationship between atrial fibrillation and mortality after stroke, we studied 186 men and 167 women from the Waikato Stroke Registry whose mean age was 75.2 +/- 7.5 years. Twenty-three percent (82 of 353) had atrial fibrillation or flutter on their admission electrocardiogram. This group differed significantly from that with sinus rhythm in three respects: 1) They were older (p less than 0.01); 2) they had more severe current stroke deficit as evidenced by lower limb power (p less than 0.05) and Mini-Mental State Score (p less than 0.001), higher incidence of homonomous hemianopia (p less than 0.05), and lower incidence of lacunar syndrome stroke (p less than 0.001); and 3) they had a significantly higher incidence of cardiomegaly and congestive heart failure (p less than 0.01). Functional outcome was insignificantly better in the group with sinus rhythm. During a mean follow-up period of 18 months, mortality was significantly higher in the group with atrial fibrillation (p = 0.001). Proportional hazards modeling, however, showed that the apparently poorer survival in those patients with atrial fibrillation could be explained by factors other than cardiac rhythm, such as age, Mini-Mental State Score, level of consciousness, and interstitial edema on admission chest radiograph. Thus, atrial fibrillation was not an independent predictor of survival after stroke.
Stroke 1991 Feb
PMID:Atrial fibrillation after stroke in the elderly. 186 58

To determine the prevalence of cardiac disorders as risk factors for stroke, we conducted a survey in 1986 in a stratified random sample of the population of Rochester, Minnesota, 35 years of age or older. The medical records of the 2,122 subjects in the sample were retrieved with use of the Rochester Epidemiology Project medical records linkage system. The data were used to estimate (1) the reliability of self-reported information about cardiac and cerebrovascular disorders and (2) the age- and sex-specific prevalence of diabetes mellitus and various cardiac and cerebrovascular conditions. The estimated prevalence for selected risk factors in the population 35 years of age or older was 5.8% for diabetes mellitus, 3.3% for myocardial infarction, 1.2% for mitral valve disease, 4.2% for left ventricular hypertrophy, and 2.8% for atrial fibrillation or flutter. These data can be used to estimate resources required for evaluation and management of the disorders. When the prevalence and the relative risk for stroke are known for a particular cardiac disorder, the proportion of stroke attributable to that disorder can be estimated.
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PMID:Prevalence of cardiovascular disease and diabetes mellitus in residents of Rochester, Minnesota. 224 50

Complex adjustments in contractility, resistance, stroke volume and atrio-ventricular contraction relationships underlie the optimization of cardiac output during variations in sinus rate. In patients with intra AV nodal re-entry tachycardia and accessory pathway tachycardias, rate and loss of appropriately timed atrial transport reduce cardiac efficiency, but this is serious only when heart rates are very high. True atrial tachycardia, atrial fibrillation, and atrial flutter are often associated with cardiovascular disease. In atrial fibrillation and flutter, loss of atrial transport may be less important than the hemodynamic consequences of irregularity of ventricular systole. Antiarrhythmic management may ameliorate the consequences of the arrhythmia by reducing heart rate, restoring sinus rhythm or more controversially by regularizing ventricular contraction. Digoxin and antiarrhythmic surgery have little negative inotropic potential but most other antiarrhythmic drugs and ablation procedures depress myocardial function. Antitachycardia pacemakers may produce acute adverse hemodynamic effects depending upon the type of pulse trains delivered to terminate the tachycardia.
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PMID:Hemodynamic consequences of supraventricular tachycardias and their antiarrhythmic treatment. 306 35

Non-invasive carotid artery testing was performed on 500 consecutive patients with visual disturbances not related to local ophthalmic pathology to determine the extent of carotid artery disease, particularly in patients with symptoms not typical of amaurosis fugax. Three hundred eighty six patients (77.2%) had an abnormal study. However, the incidence of hemodynamically significant lesions was only 16%. The patients could be divided into three groups: Patients with symptoms that could be explained on an ocular basis, including amaurosis fugax, had a 79% incidence of ipsilateral carotid plaques. Patients with symptoms which could not be easily explained on an ocular basis, such as bilateral blurred vision, bilateral visual loss (both transient and permanent), and homonymous hemianopsia had an incidence of carotid artery plaques similar to patients with amaurosis fugax. Patients with unilateral blurred vision and bilateral scintillations had a lower incidence (57%) of carotid plaques than the other groups. Younger symptomatic patients had less carotid plaques than the overall series. Twenty-one percent of patients under age 50 had the Doppler finding of early systolic flutter turbulence, which is usually of mitral valve origin. Women predominated in the under 50 age group by about 2:1. In view of the prevalence of carotid plaques in the population of patients with visual symptoms other than amaurosis fugax, evaluation of these patients with non-invasive testing is indicated to determine which of these patients has hemodynamically significant obstruction to flow at the carotid artery bifurcation.
Stroke
PMID:Visual disturbance and carotid artery disease. 500 symptomatic patients studied by non-invasive carotid artery testing including B-mode ultrasonography. 352 Sep 77

The frequency and severity of cardiac arrhythmias were studied in 70 patients with spontaneous subarachnoid hemorrhage investigated prospectively with 24-hour Holter monitoring. Patients were less than 70 years old and without clinical and/or ECG signs of previous heart disease; Holter monitoring was initiated within 48 hours of subarachnoid hemorrhage. Arrhythmias were detected in 64 of the 70 patients (91%). Twenty-nine of the 70 patients (41%) showed serious cardiac arrhythmias; malignant ventricular arrhythmias, i.e., torsade de pointe and ventricular flutter or fibrillation, occurred in 3 cases. Serious ventricular arrhythmias were associated with QTc prolongation and hypokalemia. No correlation was found between the frequency and severity of cardiac arrhythmias and the neurologic condition, the site and extent of intracranial blood on computed tomography scan, or the location of ruptured malformation. The extremely high incidence of cardiac arrhythmias, sometimes serious, in the acute period after subarachnoid hemorrhage and the absence of clinical and radiologic predictors make systematic continuous ECG monitoring compulsory to improve the overall results of subarachnoid hemorrhage, irrespective of early or delayed surgical treatment.
Stroke
PMID:Subarachnoid hemorrhage: frequency and severity of cardiac arrhythmias. A survey of 70 cases studied in the acute phase. 359 Feb 46

We evaluated the frequency of cerebral infarction in 131 patients with Duchenne's muscular dystrophy, myotonic dystrophy, Becker's muscular dystrophy, or Friedreich's ataxia. Electrocardiographic abnormalities were found in 83% of patients with Duchenne's muscular dystrophy, 56% with myotonic dystrophy, 50% with Becker's muscular dystrophy, and 25% with Friedreich's ataxia. Atrial flutter occurred in 2.3% of the patients, and atrial fibrillation in only 0.9%. Evidence of cerebral infarction was found in only 2 patients (1.5%). Both patients had cardiomyopathy and either atrial fibrillation or flutter. Despite frequent cardiac involvement, cerebral infarction is an uncommon occurrence in patients with inherited neuromuscular diseases.
Stroke
PMID:Frequency of cerebral infarction in patients with inherited neuromuscular diseases. 360 8


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