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

A 79-year-old man presented with dilated cardiomyopathy and chronic atrial fibrillation. A DDD pacemaker was implanted due to sick sinus syndrome. His left ventricular ejection fraction was 23%. He was repeatedly admitted with congestive heart failure. Although cardiac resynchronization therapy was attempted, insertion of a pacing lead into the coronary sinus failed. Right ventricular bifocal pacing was done. The QRS width was shortened to 155 msec during bifocal pacing and 157 msec during right ventricular outflow pacing from 221 msec during right ventricular apical pacing. Heart failure was improved from New York Heart Association class III to II. Regional wall motion was assessed by strain of the myocardium. Bifocal pacing increased stroke volume due to improvement of longitudinal dyssynchrony of the septal and lateral walls. Bifocal pacing is effective for patients with severe congestive heart failure in whom biventricular pacing therapy has failed. Strain Doppler imaging is useful for the assessment of regional wall motion during cardiac pacing.
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PMID:[Assessment of regional wall motion using strain Doppler imaging during right ventricular bifocal pacing in a patient with severe congestive heart failure: a case report]. 1537 39

We reported a 61-year old man with cardioembolic stroke manifested by isolated tonic seizure of the left upper limb. He had a history of chronic atrial fibrillation and transient ischemic attack. He was brought to our hospital by ambulance, when he suddenly had isolated tonic seizure of left upper limb. On admission, he had no neurological symptoms and signs. Brain diffusion weighted MR image disclosed high intensity area in the right parietal lobe, although T2-weighted image did not show any abnormalities. On 8th day, a high intensity area was observed both on the diffusion-weighted and T2-weighted MR images. In case of isolated tonic seizure of left upper limb, careful examination of stroke is required especially if the patient had a high risk of stroke.
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PMID:[Cardioembolic stroke manifested by isolated tonic seizure of the left upper limb]. 1611 36

A retrospective study was made of 200 consecutive patients with first-ever ischaemic stroke, admitted to Jordan University Hospital over a 2-year period. The mean age was 61.2 years (range 29-95). The most common stroke subtype was lacunar infarct (51.5%), but frequency of cardioembolic stroke was low (8.0%). Hypertension, diabetes mellitus and smoking were the most common risk factors for atherosclerotic non-cardioembolic stroke. Chronic atrial fibrillation was the most common risk factor for cardioembolic stroke. No patient had severe extracranial carotid or vertebral artery stenosis (> 50% narrowing). Lacunar strokes presented predominantly as pure motor stroke (67/103) and were mainly in the internal capsule (34/ 103). The favourable outcome (85% discharged home) may be due to the relatively young age and the predominance of lacunar infarcts.
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PMID:Ischaemic stroke in Jordan: a 2-year hospital-based study of subtypes and risk factors. 1620 19

Atrial fibrillation is one of the most common cardiac arrhythmia met in clinical practice. Nonregular heart rhythm leads to haemodynamic disturbances and favors thromboembolic complications--most frequently ischemic strokes. Cardioembolic strokes have different symptomatology compared with atherothrombotic strokes. They are characterised by more sudden onset, frequent haemorrhagic transformation and worse prognosis. Until now there is no clear explanation of unfavourable course of stroke in these patients. Concomitant diseases and sudden artery closure in subjects with undeveloped collateral circulation are considered as resulting in more extensive infarct size. Also impact of different forms of atrial fibrillation on the course of cerebrovascular events is not established. Paroxysmal and chronic atrial fibrillation have different influence on haemodynamic and hemostatic parameters what may play an important role in course of acute phase of ischemic stroke. Based on the results of clinical and preclinical studies, the set of data concerning the effects of different forms of atrial fibrillation on acute stroke outcome and actual guidelines of cardioembolic acute stroke treatment are presented.
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PMID:[Effects of atrial fibrillation on clinical outcome of cerebral ischemic stroke]. 1637 33

Patients with atrial fibrillation are at significant risk for sustaining a thromboembolic stroke. More than 90% of thromboemboli form in the left atrial appendage. Ligation of the left atrial appendage to reduce the risk of stroke is often performed in connection with other cardiac surgical procedures. As a stand-alone procedure, however, left atrial ligation has generally been deemed too invasive and has gained little support as an alternative therapeutic option. We report a case of port-access robotic-assisted left atrial ligation as a stand-alone procedure in a patient with chronic atrial fibrillation in whom anticoagulation was a contraindication. To our knowledge, this is the first reported case of stand-alone robotic-assisted left atrial ligation in the literature.
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PMID:Robotic-assisted left atrial ligation for stroke reduction in chronic atrial fibrillation: a case report. 1638 71

The use of warfarin in the elderly, particularly for stroke prevention in chronic atrial fibrillation, is steadily increasing. Although the benefits of warfarin are greatest in the elderly, so are the risk of adverse outcomes and the difficulties of anticoagulant management. Clinical systems need to improve to counter this therapeutic dilemma, as warfarin is likely to remain the only widely available oral anticoagulant for the foreseeable future. Aspects that require attention are: the careful selection of patients in whom treatment with warfarin is appropriate; initiating therapy in a low dose (e.g., 2.5-5 mg/day); thorough education of patients and carers; close monitoring, especially with any change in the patient's regular drug therapy; involving patients more in the management of their warfarin therapy (self-monitoring/management in suitable patients); and ongoing review of the appropriateness of therapy as circumstances change.
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PMID:The risks of warfarin use in the elderly. 1677 85

Acromegaly is characterized by a hypersecretion of growth hormone and is frequently associated with valvular abnormality and arrhythmia. The increased morbidity and mortality is primarily caused by stroke and cardiovascular disease. Therefore, valve reconstruction and sinus rhythm recovery will be particularly beneficial. We report herein the successful surgical treatment of two patients with combined valvular insufficiency and chronic atrial fibrillation in the setting of acromegaly.
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PMID:Valve repair with maze procedure in acromegaly. 1686 91

CAD is the most common cause of death in older persons and was present in 43% of 1,160 men and in 41% of 2,464 women, mean age 81 years. Hypertension was present in 60% of these older women and in 57% of these older men. The prevalence of valvular aortic stenosis, aortic regurgitation, mitral regurgitation, and MAC increases with age in older men and in older women. The prevalence and incidence of CHF increase with age. CHF is the most common cause of hospitalization in persons aged 65 years and older. The prevalence of normal LV ejection fraction associated with CHF increases with age and is higher in older women than in older men. The prevalence of chronic atrial fibrillation increases with age and was present in 16% of 1,160 older men and in 13% of 2,464 older women. Atrial fibrillation is an independent predictor of new coronary events and thromboembolic stroke in older persons. Older persons who have unexplained syncope should have 24-hour ambulatory electrocardiograms to determine whether pauses of longer than 3 seconds are present that require permanent pacemaker implantation.
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PMID:Heart disease and aging. 1696 46

Atrial fibrillation, a major risk factor for stroke, is believed to occur first as paroxysmal episodes, gradually becoming more persistent, and finally progressing to chronic atrial fibrillation. Treatment of paroxysmal atrial fibrillation is an important target to prevent chronic atrial fibrillation. We describe a very unique case with postprandial hyperglycemia and obesity associated with drug-refractory paroxysmal atrial fibrillation. A 73-year-old Japanese woman with postprandial hyperglycemia suffered from drug-refractory paroxysmal atrial fibrillation. A 1600 kcal/day diet and walking three times/day for more than 30 min eliminated paroxysmal atrial fibrillation after 6 months. Diet and exercise should be considered as the initial therapy in patients with paroxysmal atrial fibrillation who also have postprandial hyperglycemia. This case suggests that postprandial hyperglycemia and insulin resistance might be one of the possible underlying mechanisms of paroxysmal atrial fibrillation.
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PMID:Postprandial hyperglycemia is a possible contributor to paroxysmal atrial fibrillation: a case report. 1744 43

The role of permanent pacing for the prevention of atrial fibrillation is reviewed. A moderate decrease in the incidence of acute and chronic atrial fibrillation has been seen with atrial pacing compared with ventricular pacing, especially in patients with sinus node dysfunction based on a meta-analysis of clinical trials. A variety of different pacing algorithms have been studied in small numbers of patients for only short durations of time and have shown an inconsistent effect on different measures of atrial fibrillation burden. The interatrial septum or Bachmann's bundle has been shown in some, but not all, studies to have a beneficial effect on reducing the incidence of atrial fibrillation. Less well studied is the combined benefit of alternate site atrial pacing combined with atrial fibrillation prevention pacing algorithms. Device measurement of the duration of atrial fibrillation appears to be an accurate measure of disease burden, and preliminary evidence suggests that atrial fibrillation burden is associated with an increased risk of stroke and death. Future studies are needed to demonstrate the long-term efficacy of device algorithms for the prevention or termination of atrial fibrillation.
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PMID:Pacing therapy for prevention of atrial fibrillation. 1733 92


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