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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two young patients with mitral valve prolapse and an ischemic disorder of the cerebral circulation were examined. The authors discuss the role of mitral valve prolapse in the pathogenesis of ischemic cerebral stroke in young patients.
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PMID:[Role of mitral valve prolapse in the pathogenesis of cerebral infarction]. 407 24

One hundred and eighty-four consecutive patients admitted to an Investigative Stroke Unit with transient ischemic attacks (TIA) and cerebral infarction (stroke) had 48-hour automated arrhythmia monitoring, 55 patients had additional Holter monitoring and 127 patients had 2-D echocardiography. One hundred and sixteen presented with stroke (63%) and 68 patients with TIA (37%). One hundred and twenty-two were men (66.3%) and 62 were women (33.7%), mean age 63.5 years, range 25-86. The monitoring identified twelve (6.5%) patients with significant arrhythmias undetected by history, examination and admission electrocardiogram: six with atrial fibrillation (AF), four with 2 degrees heart block type Mobitz II and one each with 3 degrees heart block and sick sinus syndrome. Two-D echocardiography showed a previously unknown potential source for cardiac emboli in 22 patients (17.3%): segmental ventricular disease in eleven, mitral valve prolapse in seven, left ventricular thrombus in six, left ventricular aneurysm in three and one each with mitral valve endocarditis and global myocardial dysfunction. Only the mitral valve findings were expected on the basis of a previous M-mode echocardiographic study carried out in our city on healthy elderly volunteers. From the clinical history and all cardiac investigations, we found 59 patients (32%) with a possible cardiac source for cerebral emboli. After cerebral angiography, 29 of these 59 patients also showed a vascular lesion in the appropriate carotid artery and we could not decide definitely which lesion was responsible for the cerebral embolus. In the remaining 30 patients (16.4%), the evidence implicated the heart as the most likely source.(ABSTRACT TRUNCATED AT 250 WORDS)
Stroke
PMID:Value of cardiac monitoring and echocardiography in TIA and stroke patients. 408 26

Patients with symptoms of cerebral ischemia are often evaluated with non-invasive carotid artery testing. An abnormal carotid Doppler ultrasound frequency shift pattern of early systolic flutter (ESF) was demonstrated by auscultation and velocity wave form analysis in patients with normal carotid bifurcations. Ten of these patients were studied with echocardiography (echo) and eight had mitral valve prolapse (MVP). To evaluate the association between ESF and MVP, a prospective blinded study was performed, recording carotid Doppler frequency shift in 50 patients referred for routine echocardiography. A total of 18 patients had ESF: 9/12 patients with MVP by echocardiography had ESF. Nine additional patients without MVP had ESF (two with mitral regurgitation and two with redundant mitral valves). The association of ESF with MVP was significant (p less than 0.001). The findings of ESF with a normal carotid artery by non-invasive testing suggests a possible mitral valve origin for symptoms of cerebrovascular disease.
Stroke
PMID:Detection of mitral valve abnormalities by carotid Doppler flow study: implications for the management of patients with cerebrovascular disease. 408 30

The etiology of cerebrovascular disease (CDV) in young patients is difficult to establish if the common causes of a focal neurological deficit are excluded by appropriate investigations. Since in some observations prolapse of the mitral-valve (MVP), alterations of platelet function, or both have been linked with cerebral ischemic events, we studied the in vivo platelet release reaction and the incidence of MVP in 47 patients (12 males, 35 females) under 45 years of age with TIA or stroke of unknown cause and in an age- and sex-matched control group. The mean plasma beta-thromboglobulin (beta-TG) level of the patients (mean = 54.9 +/- 31.4 ng/ml) was significantly higher than that of the controls (mean = 20.6 /- 6.9 ng/ml, p less than 0.001). MVP was demonstrated in 13 of 47 patients in contrast to 4 of the controls (p less than 0.01). However, the beta-T levels of patients with MVP (n = 13, 52.9 +/- 25.5 ng/ml) did not differ from those of patients without MVP (n = 34, 55.7 +/- 33.7 ng/ml) significantly (p less than 0.4). Our results confirm that the incidence of MVP is higher in young patients with cerebral ischemia of unknown cause than in asymptomatic controls. The significantly elevated plasma beta-TG concentrations in the patient's group indicate an increased platelet activity in vivo. Since there was no significant difference between beta-TG levels of patients with and without MVP, the mitral-valve abnormality can not be the cause for the altered platelet activity.
Stroke
PMID:Cerebral ischemia in young patients: it is associated with mitral valve prolapse and abnormal platelet activity in vivo? 621 70

The aim of this study was to examine whether small biopsy specimens are representative of the whole human skeletal muscle or whether the different fibre types are unevenly distributed at different depths of the muscle. Ten micrometre thick cross-sections of whole human tibialis anterior were prepared using LKB PMV Cryo-Microtomes with a stroke length of 160 to 480 mm and the sections were stained for myofibrillar ATPase according to a modified procedure. The total and relative number of different fibres (Types 1 and 2) was determined in every 9th mm2 of the section. The data obtained were analysed by means of a computer program, which allowed assessment of bivariate data in the form of contour plots. The total number of fibres varied greatly between individuals (from 96 000 to 162 000; five individuals). The relative number of different fibres varied systematically in all individuals as a function of depth in the muscle. There was a gradual, often dramatic, relative increase in Type 2 fibre occurrence from the surface of the muscle (about 10--25%) towards the deeper regions (30--50%), the maximum being approximately along a line slightly posterior to the middle of the muscle. Additionally, superficial peaks were seen in places. In conclusion, the fibre type distribution in the tibialis anterior is not random. These results point to the importance of defining biopsy depth.
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PMID:Distribution of different fibre types in human skeletal muscles. I. Method for the preparation and analysis of cross-sections of whole tibialis anterior. 634 6

To study the pathophysiology and the pathogenesis of hypertensive cardiac diseases such as cardiac hypertrophy and ischemic heart diseases, and to determine the relationship between these cardiopathies, spontaneously hypertensive rats (SHR) and stroke-prone SHR (SHRSP) were used as models. Vectorcardiography was applied to the rat according to orthogonal Takayasu lead system and "vectorcardiography for small animals" with a good reproducibility was established. Characteristic vectorcardiogram (VCG) was obtained from 5-month-old SHR, compared with normotensive Wistar-Kyoto rats (WK). Left superior (posterior) deviation of QRS vector usually with ST-T changes was recognized as LVH (Left Ventricular Hypertrophy) pattern of SHR and such corresponded to the pathological findings of the increased heart weight and the increased weight and thickness of the left ventricular wall, and also to the high blood pressure. Macroscopical morphological features of the heart were also studied. Chest roentgenography showed and increased cardiothoracic ratio (CTR) and the protrusion of the left ventricular portion in the posteroanterior cardiac silhouette of SHR. The horizontal view of the chest, cross-sectioned by the apparatus of whole body autoradiography, PMV-cryomicrotome 450 MP, indicated the left anterior orientation of the interventricular septum in rats, as is the case in humans, and the clockwise rotation of the left ventricular cavity in SHR, compared with WK. The coronary arterial wall thickening with narrowed lumen was noted even in the prehypertensive 1-month-old SHR. Such correlated well with the wall thickening of the left ventricle. From these vectorcardiographical and morphological studies on SHR and SHRSP, genetic hypertension was ascertained to be significant not only for cardiac hypertrophy but for the coronary arterial wall thickening, both of which may also enhance the myocardial lesions in SHR, particularly in SHRSP.
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PMID:Vectorcardiographical and pathological approach to the relationship between cardiac hypertrophy and coronary arteriosclerosis in spontaneously hypertensive rats (SHR). 644 32

Thirty pediatric patients with isolated mitral valve prolapse were studied in order to elucidate the clinical manifestations and the natural history of this condition in children. The mean age at the time of diagnosis was 9.5 years, with a mean follow-up of 5 years. The evaluation of all 30 patients included: clinical examination by a pediatric cardiologist, ECG, chest X-ray, echocardiography and Holter monitoring. Two patients underwent cardiac catheterization and angiography, and two patients required antiarrhythmic medication for symptomatic ventricular tachycardia. No progression of mitral insufficiency was observed during the follow-up period. There were no instances of subacute bacterial endocarditis, cerebral vascular accident or sudden death. The prognosis of mitral valve prolapse appears to be favorable in childhood.
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PMID:Clinical spectrum and natural history of isolated mitral valve prolapse in 30 children. 646 72

We evaluated 32 young patients with mitral valve prolapse (MVP) as the only recognized cause of cerebral ischemia. The mean follow-up from the time of the first ischemic event was 8 years. At the time of the follow-up evaluation, 24 patients (75%) had a normal cardiac examination, and 4 had midsystolic clicks; only 1 had the characteristic click-murmur. In 75%, the first ischemic event was stroke. When MVP-associated ischemia was recognized, 44% had recurrent ischemic events. In the mean 4-year period between diagnosis of MVP-associated ischemia and follow-up, 16% had recurrent ischemic events, but none had a new persistent deficit from these events. At the time of follow-up, 63% of patients were taking platelet antiaggregants or anticoagulants. These data suggest a good prognosis for recurrent ischemic events after diagnosis of MVP-associated ischemia.
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PMID:Mitral valve prolapse and cerebral ischemic events in young patients. 653 42

In the study of cardiac abnormalities responsible for the development of cerebral embolism two-dimensional echocardiography was performed on 350 patients with ischemic cerebrovascular disease. The results were compared with those obtained from 350 controls without any history of stroke. Atrial fibrillation was detected on ECG in 115 cases (33%) of the patients and in 35 cases (10%) of the controls (p less than 0.001). The structural cardiac diseases observed in stroke patients were: rheumatic heart disease (RHD) in 37, congestive cardiomyopathy (CCM) in 7, hypertrophic cardiomyopathy (HCM) in 19, mitral annulus calcification (MAC) in 29, mitral valve prolapse (MVP) in 9, and myocardial infarction (MyI) in 10 patients. Controls were found to have these lesions in 11, 2, 3, 12, 4 and 9 patients respectively. RHD (p less than 0.001), HCM (p less than 0.01) and MAC (p less than 0.01) were significantly more frequent in patients with ischemic cerebrovascular disease, but not MyI, CCM or MVP. Intracardiac thrombi were diagnosed in 29 cases of patients and in 4 cases of controls (p less than 0.001). Our data suggested that nonrheumatic heart diseases such as MAC and HCM could also be considered as causes of embolic stroke. The reasons for the variable frequencies of cardiac abnormalities reported in the literature for stroke patients are discussed.
Stroke
PMID:Cardiac abnormalities in ischemic cerebrovascular disease studied by two-dimensional echocardiography. 665 29

Mitral valve prolapse (MVP) is a predisposing factor for cerebral ischemia, especially in young adults. Cerebral embolization of intracardiac thrombi is the probable mechanism in many cases. Platelets play a key role in the development of thrombi. We found that platelet factor 4, a marker protein of platelet activation, was elevated in 12 of 33 MVP patients (36%) without a history of stroke. This finding indicates that platelets are frequently activated in asymptomatic MVP patients and may allow identification of a subgroup of MVP patients with activated platelets who are at increased risk for emboli.
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PMID:Platelet activation and mitral valve prolapse. 668 86


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