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

The usefulness of pulmonary-artery cineangiocardiography (PACAC) to demonstrate intracardiac thrombi in patients with cerebral infarctions of possible embolic origin has been explored. PACAC was performed in 60 patients (mean age 74 years) with sudden onset of permanent neurological deficits in whom CT scan and CSF analyses had excluded intracerebral hemorrhage. Opacification of the left atrium was excellent in 52 (87%) investigations, acceptable in 7 and poor in 1. Among 33 patients with chronic atrial fibrillation, an atrial thrombus was demonstrated in 8 (24%) and a suspected thrombus in 3. Atrial clot was also demonstrated in a patient with intermittent atrial fibrillation. In 4 out of 14 patients with previous myocardial infarction, a ventricular thrombus was demonstrated. Ventricular clots were detected in 2 of 46 patients without known previous myocardial infarction. No major complications occurred during the investigation. PACAC can be to used in the search for atrial or ventricular thrombi when cardiac source of a cerebral embolus is suspected. About 1 out of 3 patients with atrial fibrillation has remaining intracardiac thrombus after stroke.
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PMID:Pulmonary-artery cineangiocardiography to demonstrate cardiac thrombi in patients with cerebral infarction. 670 17

Beat-to-beat left ventricular ejection was evaluated in a group of 20 patients with chronic atrial fibrillation using a computerized single probe detector. The reference group consisted of 10 patients with sinus rhythm. For each patient 30 successive cardiac cycles were analyzed and the relative variations of four parameters were assessed: R-R interval, diastolic and systolic time intervals, and ejection amplitude, corresponding to the left ventricular stroke volume. The mean variations were respectively 3.4%, 10.4%, 8.4%, and 11.8% in patients with sinus rhythm, and 21.9%, 37.9%, 10.6% and 30.5% in patients with atrial fibrillation. This demonstrates that changes in ejection are mainly related to the duration of the filling phase, with nearly constant systolic times. Correlations between R-R intervals and systolic ejection amplitudes were highly significant (P less than 0.001) in patients with atrial fibrillation in 85% of cases. This information complements the average ejection fraction obtained from multiple cycle superimposition.
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PMID:Beat-to-beat assessment of left ventricular ejection in atrial fibrillation. 687 96

The maze operation is a newly developed surgical procedure for patients with chronic atrial fibrillation. Between may 1993 and october 1994, 11 patients underwent mitral valve surgery combined with the maze procedure, 10 for chronic, medically refractory, symptomatic atrial fibrillation and 1 for intermittent, symptomatic atrial flutter. In one patient, a double aorto-coronary venous bypass was added. The operative mortality was 9%: one patient died on the 7th postoperative day from a perioperative cerebrovascular accident. Postoperatively, electrophysiological and stress testing as well as transthoracic or transesophageal echocardiography (TTE; TEE) were performed. All patients were in sinus rhythm. Left and right atrial contractions were analyzed by TTE/TEE and the atrial transport function was documented in each patient. The postoperative exercise stress test revealed slight sinus-node incompetence. After a mean follow-up time of 10.4 +/- 5.4 months (1 to 16 months) all surviving patients are free from atrial fibrillation or flutter and without need for medication. The maze operation, which we performed for the first time in connection with mitral valve surgery, is a successful treatment for chronic, medically refractory atrial fibrillation and intermittent, symptomatic atrial flutter. This procedure provides a sinus rhythm with atrioventricular synchrony, restores the atrial transport function and obviates the need for antiarrhythmic drugs. Long-term anticoagulation appears unnecessary.
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PMID:[The maze operation: surgical therapy of chronic atrial fibrillation]. 767 30

Vitamin K-antagonists are recommended for the prevention of stroke in patients with chronic atrial fibrillation, recent myocardial infarction or prostatic heart valves. Anticoagulant therapy is seldom prescribed, however, presumably for fear of haemorrhagic sequelae. The risk of bleeding during anticoagulant therapy has been evaluated in 10 recent studies of warfarin treatment for the prevention of arterial thromboembolism. The mean annual incidences of fatal and major bleeding was 0.5 percent and 1.6 percent, respectively, as compared with the placebo figures of 0.1 percent and 0.6 percent, respectively. In 3 studies where the effect of aspirin has been evaluated the mean annual incidence of fatal and major bleeding was 0.2 percent and 0.8 percent, respectively. The figures for warfarin therapy where lower than those reported from older studies. The reasons for the reduction in incidence may be less intensive anticoagulant treatment than formerly, improved laboratory control by the introduction of the International Normalized Ratio, and careful pretreatment evaluation of patients selected for clinical trials.
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PMID:[Bleeding complications in oral anticoagulant treatment]. 772 54

The management of atrial fibrillation is evolving in response to recently published data. Low-risk patients with new-onset atrial fibrillation may not need to be hospitalized. Beta blockers may be the most effective drugs for controlling the heart rate. When a patient does not respond to drug therapy, it is still appropriate to search for the cause of the arrhythmia and to use direct-current cardioversion. Clear evidence now exists that patients with chronic atrial fibrillation should be given anticoagulant drugs to reduce the risk of stroke. Antiarrhythmic drugs should be used cautiously, because they may cause life-threatening arrhythmias.
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PMID:The management of atrial fibrillation: current perspectives. 770 83

Atrial fibrillation is the second most common arrhythmia after ventricular premature beats. For years, prophylactic anticoagulation has been recommended in patients with atrial fibrillation in underlying rheumatic heart disease. With the aim of establishing the risk of embolism in non-rheumatic atrial fibrillation, and the justification for prophylactic anticoagulation therapy, five prospective studies were carried out. The results obtained indicate that all patients with chronic atrial fibrillation should receive anticoagulation therapy wherever possible (INR 2.0 to 3.0). The sole exception are patients aged under 55 years with no other organic heart disease. For this group, the risk of a stroke is appreciably reduced, so that treatment with ASA suffices.
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PMID:[Anticoagulation in non-rheumatic atrial fibrillation. Recommendations based on five prospective studies]. 814 16

Strokes are responsible for significant morbidity and mortality. Persons who have chronic atrial fibrillation are at higher risk of having a stroke. Previously, anticoagulation with warfarin was instituted only in persons with atrial fibrillation associated with valvular problems. More recently, five studies have shown a clear benefit to using warfarin in persons with atrial fibrillation related to nonvalvular conditions, such as hypertension, coronary artery disease, and heart failure. Patients who were given warfarin in therapeutic dosages, as measured by prothrombin time ratios and International Normalized Ratios (INRs), had a significant reduction in stroke risk ranging from 37 to 79% in the five studies. The outcomes of these five studies have changed the way persons with chronic, nonvalvular atrial fibrillation are managed. Health care providers play a key role in the counseling of patients who are considering the use of warfarin, the patient education regarding potential complications and drug interactions, and the ongoing monitoring and laboratory testing needed for dosage adjustments.
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PMID:Reducing the risk of stroke in patients with chronic, nonvalvular atrial fibrillation. 818 82

A resurgence of interest in atrial fibrillation has led to research in several avenues. Observations on the behavior of the atrium during atrial fibrillation demonstrate that electrical activity is not entirely random and that sinus node activity persists despite surrounding fibrillation. Anticoagulation therapy for chronic atrial fibrillation is now accepted as optimal treatment, but randomized trials have excluded the majority of patients screened and the risk-benefit ratio of therapy in the average patient therefore remains unclear. This is being addressed in comparative trials of warfarin and aspirin and in an analysis of risk factors for stroke derived from a major trial. Assessment of the efficacy of therapy for the control of ventricular rate in atrial fibrillation has underscored the slow action of digoxin and raised the issue of suboptimal dosing. With the recognition that improvement of exercise capacity following cardioversion may be postponed for weeks, several studies have evaluated serial changes in ventricular function and shown that in some patients sinus rhythm is associated with an improved ejection fraction. Transesophageal echocardiography is an area of intense interest for the identification of patients at high risk of thromboembolism following cardioversion, and the significance of left atrial spontaneous echo contrast as well as the left atrial appendage contractile function are being investigated. Finally, new methods of arrhythmia termination are being evaluated and developed, and surgical approaches to atrial fibrillation are being expanded and refined.
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PMID:Current management of atrial fibrillation. 819 69

Long term oral warfarin should be administered to elderly patients with atrial fibrillation who are at high risk for developing thromboembolic stroke and who have no contraindications to anticoagulant therapy. Oral aspirin (acetylsalicylic acid) 325mg daily may be given to elderly patients with chronic atrial fibrillation who have contraindications to anticoagulant therapy or who are not at high risk for developing thromboembolic stroke. Management of atrial fibrillation includes treatment of the underlying disease and precipitating factors. If patients have paroxysmal atrial fibrillation with a very rapid ventricular rate associated with hypotension, severe left ventricular failure or chest pain due to myocardial ischaemia, immediate direct-current cardioversion should be performed. Intravenous verapamil, diltiazem or a beta-blocker should be used for immediate slowing of a very rapid ventricular rate associated with atrial fibrillation. If a rapid ventricular rate associated with atrial fibrillation persists at rest or during exercise despite digoxin, then oral verapamil, diltiazem or a beta-blocker should be added. Low dosages of oral amiodarone (200 to 400 mg/day) may be used in selected patients with symptomatic life-threatening atrial fibrillation refractory to other therapy. No medication which depresses atrioventricular conduction should be given to patients with atrial fibrillation and a slow ventricular rate. Cardioversion should not be performed in asymptomatic elderly patients with chronic atrial fibrillation. This author would use a beta-blocker for control of ventricular arrhythmias and following conversion of atrial fibrillation to sinus rhythm. Should atrial fibrillation recur, beta-blockers have the additional advantage of slowing the ventricular rate.
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PMID:Optimal management of older patients with atrial fibrillation. 819 93

We describe the case of a 73-year-old man with cardiac failure due to hypertensive heart disease, chronic atrial fibrillation, prior ischemic stroke and acute ischemia of the left leg probably embolic in nature, in whom transthoracic echocardiography (TTE) detected a large left atrial mass compatible with thrombus. Transesophageal echocardiography (TEE) was performed to better evaluate the atrial mass. TTE showed a mass that was firmly attached to the wall of the left atrium, compact, homogeneous and stationary, indicating a relatively low embolic risk. On the other hand TEE clearly detected a marked motility and echographic unhomogeneity of the atrial mass, suggesting a poorer prognosis and urgent surgical referral due to high impending embolik risk. This case further supports the superiority of TEE to TTE in the assessment of intracardiac masses and, in particular, of embolik risk in a patient with left atrial thrombosis.
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PMID:[Role of transesophageal echocardiography in the evaluation of the potential embolic risk in left atrial thrombosis. Report of a clinical case]. 853 6


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