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

Load-induced contractility depression, in which supernormal left ventricular ejection fraction and contractility at rest decrease by added afterload, is most often found in children with mitral valve prolapse who have symptoms. Patients have high ventricular end-diastolic pressure at rest, which is further increased by afterload challenge. The Frank-Starling mechanism may be maximally mobilized with high preload even at rest to compensate for the intrinsically depressed inotropic state. Therefore, preload reserve may be easily exhausted due to afterload addition. We aimed to determine left ventricular end-diastolic fiber length, stroke work, and contractility before and during handgrip by echocardiograms to obtain evidence for the Frank-Starling mechanism in patients and controls, including patients treated with coenzyme Q10. The subjects were divided into four groups, each consisting of 30 children aged 6-16 years: group 1, normals; group 2, patients; group 3, the same patients as in group 2 after coenzyme Q10 therapy; and group 4, patients with asymptomatic mitral valve prolapse. Baseline values and percentage increases in systolic blood pressure, heart rate, and left ventricular wall stress showed no differences among the groups. Only in group 2 were the percentage increase in ejection fraction, fiber shortening velocity, contractility, and end-diastolic dimension strongly negative, despite supernormal baseline levels. In other groups, these were significantly positive, without intergroup differences. We conclude that in the heart with load-induced contractility depression, the Frank-Starling mechanism deviates from normal. The normal Frank-Starling mechanism was recovered due to coenzyme Q10, which may improve disturbed bioenergetic function at the molecular level.
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PMID:Recovery of the Frank-Starling mechanism by coenzyme Q10 in patients with load-induced contractility depression. 824 1

We compared epidemiologic and clinical data from 310 patients with migraine and 30 patients with acute migrainous stroke to identify factors predictive of migrainous stroke and assess the risk of future stroke in these two populations. We found no significant differences in gender ratio or in the frequency of smoking, estrogen use, hypertension, mitral valve prolapse, or family history of migraine between the two groups. A history of migraine with aura was significantly more common in the migrainous stroke group (24 of 30 [80%] versus 142 of 310 [46%]; p < 0.001), as was a history of prior stroke (nine of 30 [30%] versus four of 310 [1.3%]; p < 0.001). We followed 173 of the migraine patients for at least 1 year and a mean of 35.8 months, and no strokes occurred in this group. We followed 28 of the migrainous stroke patients for a mean of 25.3 months, and there were six recurrent strokes in that group, all again migraine-associated. Migrainous stroke is more common in individuals with aura than in those who are aura-free, but this association is of little value in attempting to distinguish patients destined for migrainous stroke from the migraine population at large. Patients with a history of migraine-associated stroke are at significantly increased risk for recurrent stroke.
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PMID:Migraine and migrainous stroke: risk factors and prognosis. 805 77

Pregnancy and oral contraceptives (OCs) reduce the levels of the natural anticoagulant protein S and about 50% and 20%. respectively. Original work on the link between OCs and development of deep vein thrombosis and pulmonary embolism do not necessarily confirm an association, today since it included cohort studies of women using high estrogen OCs. Also, physicians tended to actively diagnose thrombophlebitis in women they knew were using OCs. Objective diagnostic measures, e.g., venography, were not used in the cohort studies. Decreased estrogen content of current OCs and a case control study design show the likelihood of thrombotic complications of OS use has decreased significantly. Women who have experienced an episode of venous thrombosis and are not on oral anticoagulation therapy should not use OCs, because as many of 30% experience a second episode. Women with a strong family history of thromboembolism and those with antiphospholipid antibodies who have experienced a thrombotic event should also not use OCs. Current or past use of low estrogen Ocs does not significantly increase the risk of myocardial infarction, but smoking does. Physicians doe not know, however, whether women who use an OC with at the most 30 mcg estrogen and who smoke are at greater risk than those who smoke but do not use OCs. Just one study suggests a possible association between OC use and mitral valve prolapse leading to a cerebrovascular accident. The likelihood of developing calf vein clots in women who use low-dose OCs appears to be reduced, if they use sequential compression stockings and subcutaneous low molecular weight heparin following surgery. Since OCs decrease the chance of serious bleeding during ovulation and of heavy menstrual flow, oral anticoagulation is not a contraindication to OC use. The risk of OC-associated thromboembolism is considerably lower than that of pregnancy-associated thromboembolism.
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PMID:Contraceptive choices in women with coagulation disorders. 851 43

Patent foramen ovale (PFO) is more common in patients with stroke than in matched controls, but the stroke mechanism and late prognosis are not well known. We studied features, coexisting causes, and recurrences of stroke in 140 consecutive patients (mean age 44 +/- 14 years) with stroke and PFO admitted to a population-based primary-care center. We selected the patients from 340 patients (41%) aged < or = 60 years with acute stroke. The initial event was brain infarction in 118 patients (84%) and TIA in 22 (16%). Intracranial embolic occlusions were present on angiography or transcranial Doppler in most patients admitted within 12 hours of onset, whereas a venous source was clinically apparent in only six patients (5.5%). Pulmonary embolism, Valsalva maneuver at onset, and coagulation abnormalities were rare, but one-fourth of the patients had an interatrial septum aneurysm (ISA) that coexisted with PFO. An alternative cause of stroke was present in only 22 patients (16%), usually cardiac (atrial fibrillation, severe mitral valve prolapse, akinetic left ventricular segment). During a mean follow-up of 3 years, the stroke or death rate was 2.4% per year, but only eight patients had a recurrent infarct (1.9% per year). This low rate of recurrence contrasted with the severity of initial stroke, which left disabling sequelae in one-half the patients. Multivariate analysis showed that interatrial communication, a history of recent migraine, posterior cerebral artery territory infarct, and a coexisting cause of stroke were associated with recurrence, whereas ISA and treatment type (coagulant or antiaggregant therapy, surgical closure of PFO) were not. However, given the low number of events, these findings must be taken with caution. In conclusion, our study shows that stroke associated with PFO with or without ISA is not commonly due to a coexisting cause of stroke. It is usually embolic, although a definite source cannot often be demonstrated. The presenting stroke is often severe, but recurrence is uncommon. The demonstration of factors associated with a higher risk of recurrence in subgroups of patients is critical for the long-term management of these patients.
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PMID:Stroke recurrence in patients with patent foramen ovale: the Lausanne Study. Lausanne Stroke with Paradoxal Embolism Study Group. 862 71

To determine whether potential sources of embolism such as atrial septal aneurysm (ASA), patent foramen ovale (PFO), mitral valve prolapse and atherosclerotic aortic debris can influence the outcome of patients after first cerebral ischemic event (CIE), 214 patients (124 stroke, 21 RIND, 69 TIA) were examined by transesophageal echocardiography (TEE) up to 3 weeks after CIE and followed up for 12 months. For risk estimation, the patients were subdivided into group I = without and group II = with potential sources of embolism. We additionally took into account cardiovascular diseases and atherosclerotic risk factors (group la + IIa without, Ib + IIb with). Recurrence occurred in 14 out of 214 patients (6.5%). Univariate analysis demonstrated that the presence of ASA, PFO and aortic debris as well as cardiovascular diseases and atherosclerotic risk factors was associated with a twofold to threefold higher incidence of recurrent events. While potential sources of embolism alone had no influence on the recurrence rate (group I:8/111 = 7.2% versus group II: 6/103 = 5.8%, n.s.), this was significantly different in relation to cardiovascular diseases and atherosclerotic risk factors (groups Ia + IIa: 0/66 = 0%, groups Ib + IIb: 14/148 = 9.8%, p < 0.01). Our results show that potential sources of embolism do not appear to influence the recurrence rate in cardiac healthy subjects. In patients with cardiovascular diseases, however, potential sources of embolism are associated with a higher risk of recurrence, and should therefore be imaged by TEE.
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PMID:[Potential embolism sources in transesophageal echocardiography--prognostic value in patients with cerebral ischemia]. 865 1

This review examines the results of vasodilator therapy in patients with chronic regurgitant lesions of the aortic and mitral valves. The analysis includes those studies which provide data on hemodynamic measurements, left ventricular systolic function, ventricular volumes and regurgitant flow. In patients with chronic aortic or mitral regurgitation, the short-term administration of nitroprusside, hydralazine, nifedipine or an angiotensin-converting enzyme (ACE) inhibitor produces salutary hemodynamic effects. The major difference in the response to combined preload and afterload reduction (i.e., nitroprusside) in patients with aortic versus mitral regurgitation was that forward stroke volume generally increased and ejection fraction remained unchanged in mitral regurgitation, whereas ejection fraction generally increased and forward stroke volume remained unchanged in aortic regurgitation. These observations suggest that a reciprocal relation between regurgitant and forward flow characterizes the response to preload and afterload reduction in mitral regurgitation (through a preload-dependent dynamic regurgitant orifice), whereas correction of afterload mismatch dominates the response in aortic regurgitation. In studies of long-term vasodilator therapy in patients with chronic aortic regurgitation, a reduction in left ventricular volumes and regurgitant fraction, with or without an increase in ejection fraction, has been observed during treatment with hydralazine, nifedipine and ACE inhibitors. Patients with the largest, sickest hearts generally benefit the most from treatment with vasoactive drugs. Nonetheless, favorable ventricular remodeling has been reported in asymptomatic patients, and long-term nifedipine use has delayed the need for operation in asymptomatic patients with chronic aortic regurgitation. For patients with chronic mitral regurgitation, definition of the etiology of the lesion is a prerequisite for choosing appropriate therapy. Excluding patients with obstructive hypertrophic cardiomyopathy and mitral valve prolapse, and some with fixed-orifice (i.e., rheumatic) mitral regurgitation, the signal importance of preload reduction suggests that the preferred long-term therapy for symptomatic chronic mitral regurgitation is an ACE inhibitor. There are no long-term studies that support the use of vasodilator therapy in asymptomatic patients with chronic mitral regurgitation.
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PMID:Vasoactive drugs in chronic regurgitant lesions of the mitral and aortic valves. 889 Jul 99

In patients with a load-induced cardiac dysfunction (LCD), the left ventricular (LV) stroke work is supernormal at rest, but then becomes subnormal during handgrip (HG). The LCD usually occurs in children with the mitral valve prolapse (MVP). Our catheterization study revealed that the end-diastolic pressure (EDP) of both ventricles was elevated in LCD patients. In this study, the LV and right ventricular (RV) systolic time (ET) were measured by echocardiograms. The mitral inflow peak velocities, E and A, were also measured by the pulsed Doppler method. Subjects were divided into four groups, each consisting of 16 individuals: group 1, normal children; group 2, LCD patients; group 3, recovered children from LCD, the same individuals as group 2, but after coenzyme Q10 (CoQ) therapy; and group 4, asymptomatic children with MVP. In group 2, the mean PEP and PEP/ET were significantly smaller and the peak A velocity was significantly larger than in groups 1, 3 and 4. Among groups 1, 3 and 4, no intergroup differences were found regarding the PEP/ET and A. In LCD patients, a depressed inotropic state of the myocardium may result in a high EDP due to the Frank-Starling mechanism, and such a high EDP may then cause STI changes and a large A velocity. CoQ may also return abnormal STIs in LCD patients to normal, probably by improving the inotropic state and, as a consequence, reducing the high EDP of the LV and RV to a normal level.
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PMID:Recovery of the systolic time intervals by coenzyme Q10 in patients with a load-induced cardiac dysfunction. 926 17

In stroke patients several cardiac changes associated with embolism can be detected with transoesophageal echocardiography. Potential major cardiac embolic sources (e.g. atrial fibrillation, thrombi of left ventricle/atrium, vegetation, myxoma, dilated cardiomyopathy) have a causal relationship to embolism. Other changes with no certain causal relationship are regarded as potential minor cardiac embolic sources (e.g. atrial septal aneurysm, patent foramen ovale, mitral annular calcification, mitral valve prolapse, protruding atheroma of the aorta). We compared the prevalences of major and minor potential cardiac embolic sources in a stroke population with that in controls. One hundred and twenty-one patients with first-ever stroke were compared with 68 randomly selected controls. All subjects underwent magnetic resonance imaging of the brain, carotid ultrasound and transthoracic/transoesophageal echocardiography. The patients were slightly older (mean age 70.7 +/- 10.3 years) than the controls (65.5 +/- 15.5 years) (p < 0.05). Potential major cardiac embolic sources were found in 27% of the patients and in 4% of the controls (p < 0.001). The most common major potential embolic source was atrial fibrillation, detected in 22/121 patients. Fifteen of these also had spontaneous echocontrast in the left atrium. Eleven left atrial thrombi were found (four of these patients had atrial fibrillation and seven had sinus rhythm). A history of heart disease was more common in patients with a potential major cardiac embolic source or a carotid artery stenosis (77%) than in those patients without (44%) (p < 0.01). After excluding subjects with a major potential cardiac embolic source and/or carotid artery stenosis, no differences in the prevalence of minor potential cardiac embolic sources were found between patients (55%) and control subjects (47%) (p = NS). Even when subjects without a major potential cardiac embolic source or a carotid artery stenosis were categorized into three age groups (35-54, 55-74 and > 74 years) the prevalence of potential minor cardiac embolic sources did not differ between patients and controls. To conclude, major potential cardiac embolic sources are more common in an older population with first-ever stroke than in a comparable control group. However, potential minor cardiac embolic sources did not differ in prevalence in the patients compared with controls. Certain changes (e.g. atrial septal aneurysm) might have a potential embolic role in younger stroke patients but in our study no difference was found between older stroke patients and controls.
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PMID:Cardiac changes in stroke patients and controls evaluated with transoesophageal echocardiography. 945 81

Migraine is a primary headache disorder characterized by recurring attacks of pain and associated symptoms. Migraine sufferers require a continuum of clinical care that depends on their disability and response to treatment. Treatment consists of: (1) prevention of attacks by avoidance of triggers; (2) the use of nonpharmacologic treatments; (3) treatment of the acute attack; and (4) long-term prophylactic therapy. Migraine is comorbid for affective disorders, epilepsy, stroke, and mitral valve prolapse. The therapy selected depends on the headache severity and frequency, the pattern of associated symptoms, comorbid illnesses, and the patient's treatment response profile. Acute treatment can be symptomatic or specific, using drugs such as dihydroergotamine (DHE) or sumatriptan. Preventive treatment can be episodic, subacute, or chronic. The major drug groups include beta-adrenergic blockers, anti-depressants, calcium channel blockers, serotonin antagonists, anticonvulsants, and nonsteroidal anti-inflammatory drugs (NSAIDs). These can be divided into two major categories and second-line choices.
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PMID:Migraine treatment. 947 12

A case of a 38 year-old female patient admitted to the hospital with stroke is reported. Transesophageal echodoppler cardiogram showed mitral valve prolapse associated with a vegetation on its anterior leaflet, and this vegetation was a possible embolic source. The follow-up without signs of infectious disease, the good clinical outcome and the regression of the valvar vegetation without use of antibiotics consolidated the diagnosis of nonbacterial thrombotic endocarditis. As far as it is known, this is the first reported case with antemortem diagnosis and good outcome with treatment with aspirin and ticlopidine.
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PMID:[Nonbacterial thrombotic endocarditis]. 949 28


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