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

Studies of patients with mitral valve prolapse syndrome have suggested autonomic nervous system dysfunction, but a precise definition of mechanisms is lacking. We measured supine and standing heart rate, blood pressure, cardiac output, oxygen consumption, plasma catecholamines, and blood volume in 23 symptomatic women with both echocardiographic and phonographic signs of MVP and in 17 normal control subjects. An analysis of the results revealed 2 distinct subgroups of patients: those with normal heart rates but increased vasoconstriction (Group I, n = 10) and those with orthostatic tachycardia (Group II, n = 13). Group II patients had heart rates at rest supine of 97 +/- 3 compared with 79 +/- 2 in Group I patients and 78 +/- 8 in control subjects. Estimated total blood volumes were lowest in Group I patients, intermediate in Group II patients, and highest in control subjects (p less than 0.05). Other measurements at rest supine were similar in patients and controls. After standing for 5 minutes, patients had a higher mean plasma epinephrine value, diastolic blood pressure (81 +/- 2 versus 74 +/- 3 mm Hg, p less than 0.05), and peripheral resistance (1,878 +/- 114 versus 1,414 +/- 92, dynes s cm-5, p less than 0.01), wider arteriovenous oxygen difference (6.7 +/- 0.4 versus 5.3 +/- 0.5 vol%), and lower stroke volume index (26 +/- 2 versus 33 +/- 2 ml/m2, p less than 0.01) than did the control subjects. Cardiac output was normal in Group II patients but reduced in Group I patients, who demonstrated marked vasoconstriction. No patient had evidence of a "hyperkinetic" circulatory state. A cycle of decreased forward stroke volume, vasoconstriction, and blood volume contraction appears to be present in at least some symptomatic patients with MVP.
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PMID:Abnormal cardiovascular regulation in the mitral valve prolapse syndrome. 686 79

The clinical story and the results of radiological and angiocardiographic investigations in 2 patients with proven mitral valve prolapse and cerebral ischemia are reported. Significant risk factors for stroke other than mitral valve prolapse were lacking. Cerebral angiography showed in one case a distal occlusion suggesting embolic brain lesion and was normal in the other case. This report suggests: 1) that mitral valve prolapse is a real risk factor for stroke in young people; 2) that two-dimensional echocardiography or angiocardiography are valuable investigations in young patients with cerebral ischemia, when clinical or electrocardiographical findings of cardiopathy are present.
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PMID:[Mitral valve prolapse and cerebral ischemic strokes]. 687 78

Transient cerebral ischemia and stroke may occur despite previous occlusion of the artery supplying the appropriate part of the brain. After occlusion of the internal carotid artery, emboli may pass from the "stump" of the occluded artery to later produce transient cerebral ischemia or a stroke. Transient cerebral ischemia and stroke are due to a variety of conditions, some of which are strongly correlated with platelet thromboembolism, while others have little primary relation to thrombosis. The impact of this on therapeutic considerations is obvious. Thromboembolism related to myxomatous degeneration of the mitral valve (mitral valve prolapse) is a factor to consider in determining the cause of a stroke in a younger person. The prognosis for the different varieties of threatened stroke is incompletely known. When due to arteriosclerosis of the large cerebral arteries, transient cerebral ischemia and minor strokes pose a cumulative threat for a major stroke or death of 13% in the first year, 22% in the second year and 30% in the third year.
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PMID:Randomized trial of therapy with platelet antiaggregants for threatened stroke. 2: Observations on the pathogenesis and natural history of threatened stroke. 698 64

A 30-year-old man was admitted to the hospital with a history of sudden onset of bizarre behavior and difficulty in speaking that initially was attributed to drug intoxication. Examination disclosed a confused young man with receptive and expressive aphasia. A late systolic murmur was heard in the mitral area and echocardiography confirmed the presence of mitral valve prolapse. A computed tomographic scan of the head and cerebral angiography showed abnormalities consistent with an infarct of the left temporo-occipital region. Since no other predisposing factors were present, this patient's stroke was probably related to mitral valve prolapse.
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PMID:Mitral valve prolapse: association with bizarre behavior, a confusional state, and aphasia. 709 31

All patients 20 years old or older referred for echocardiographic examination and found to have mitral valve prolapse during the period January 1975 through December 1979 were included in the study. Of the 1,138 patients, two-thirds were women and one-third were men. Their average age was 48.4 years. Forty patients (3.5%) had histories of prior focal cerebrovascular ischemic events. In 26 of the 40 patients, no responsible mechanism other than mitra valve prolapse was identified, and in 4, the ischemic event occurred during an episode of bacterial endocarditis, a known complication of mitral valve prolapse. In 10 of the 26 patients, there was clinical information to suggest an embolic mechanism for the ischemic. A conservative estimate of the prevalence rate for cerebral infarction in this group of patients is four times greater than the rate expected in a normal population. This difference is likely due to the contribution of mitral valve prolapse in the pathogenesis of cerebral infarction.
Stroke
PMID:Cerebral ischemic events in patients with mitral valve prolapse. 710 43

Two populations of patients with mitral valve prolapse were analyzed to identify factors predisposing to the development of cerebral emboli. Of 760 patients followed for up to five years by our cardiologists with echocardiographically demonstrated mitral valve prolapse (MVP), only one, aged 82 years, has had a stroke. In contrast, of 43 patients admitted to our neurology service with a cerebral embolus and no evidence of carotid or other cardiac lesion and in whom echocardiography was performed, MVP was present in 9. No contributing etiologic mechanisms were uncovered to account for the disparity between the cardiology and neurology populations. However, with the apparent increased incidence of MVP in young patients with cerebral ischemia, both groups require longitudinal follow-up to understand better the factors that predispose a small percentage of patients with mitral valve prolapse to the development of cerebral ischemia.
Stroke
PMID:Mitral valve prolapse and cerebral ischemic events. A comparison between a neurology population with stroke and a cardiology population with mitral valve prolapse observed for five years. 710 44

The incidence of stroke in the young is reported to be high in India. The role of the mitral valve prolapse (MVP) syndrome in these patients is not clear. A prospective study over a period of 1 year was carried out in order to evaluate the role of MVP in cases of stroke occurring in patients below the age of 40 years. Of the 38 cases of stroke in the young seen during this period, well-recognised risk factors of stroke could be detected in 17. MVP confirmed by M-mode echocardiography was seen in 13% of all stroke patients and in 23.8% of those in which there were no other risk factors. The incidence of MVP was much higher if only the clinical criteria for diagnosis were used. We believe that MVP is a significant risk factor in younger stroke patients, and, in such cases, merits investigation. The probable pathogenic mechanisms and therapeutic implications are discussed.
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PMID:Mitral valve prolapse and cerebrovascular accidents in the young. 713 91

The evaluation methodology of the cardiac performance has had during the last period of time the important contribution of the echocardiography. Sports cardiology is an ideal field for the use of the T-M echocardiography, for the assessment of the left ventricular performance, because of its various possibilities and non-invasive character. The review based on the data of the literature and on the author's experiences in T-M echocardiography, practised on the teenagers at rest and exercise, presents the advantages, the technical difficulties, the work methodology and the limits of the method. The use of this technique allows the measurement of the dimensions of the interventricular septum, of the posterior wall of the left ventricle and its cavity, and the dimension of the aorta; the monitoring of the valvular dynamics of the mitral and aortic valve, of the interventricular septum and posterior wall of the left ventricle at rest and during exercise; the functional evaluation of the left ventricular inotropic status by means of the determination of the cardiac index, stroke volume, ejection fraction and myocardial contractility; the possibility of a systematical control of the training effects on the development of heart in the case of children practising performance sports; the detection of some cardiac diseases (e.g. cardiomyopathy, septal hypertrophy, "silent" mitral valve prolapse), which limit the adaptation of the heart to effort. Though there are a lot of studies, the author considers that the limits of the application of echocardiography in sports medicine cannot yet be seen. The development of the ultrasound machines will allow the extension of the investigation field.
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PMID:Non-invasive assessment of left ventricular performance at rest and during exercise by T-M mode echocardiography. 714 24

A 63-year-old hypertensive woman with a prolapsing mitral valve developed sudden blindness of the left eye secondary to a central retinal artery embolus. The decision to perform carotid arteriography led to discovery of an ulcerated plaque in the left internal carotid artery, which was found at the time of endarterectomy to bear a large friable platelet thrombus. The frequent occurrence of mitral valve prolapse in normal populations suggests that this anomaly may be incidental rather than etiologic in patients with cerebral embolic phenomena. The finding of mitral valve prolapse should not routinely exclude evaluation for other sources of embolic stroke.
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PMID:Carotid-retinal embolism with coexistent mitral valve prolapse. 719 47

We assessed the use of echocardiography in the evaluation of stroke by recording M-mode and two-dimensional (2D) echocardiograms in 100 consecutive hospitalized patients. Of the 95 persons satisfactorily imaged with 2D echocardiography, 47 lacked clinical and routine laboratory evidence of heart disease; no potential embolic source or other finding that altered therapy was diagnosed by echocardiography. In the remaining 48 patients with clinical or routine laboratory evidence of heart disease, two with left ventricular thrombus as a potential embolic source were identified by 2D echocardiography. M-mode echocardiograms failed to detect the thrombus in either patient. No patients with left atrial thrombi, mitral stenosis, cardiac tumor, or vegetations suggesting endocarditis were identified. One patient had possible mitral valve prolapse. Echocardiograms in patients lacking other available evidence of heart disease are unlikely to yield findings that alter the clinical approach to patients with stroke; echocardiography in stroke patients with clinically evident heart disease may have greater clinical utility; additional study of the role of echocardiography in selected subgroups of stroke patients is indicated.
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PMID:Echocardiography in diagnostic assessment of stroke. 724 27


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