Cardiac complications stroke

It is important to obtain a baseline EKG and cardiac enzymes to evaluate the possibility of an acute myocardial infarction. The short-term (2-4 weeks) stroke risk after acute myocardial infarction (AMI) is 2.5%. Stroke is usually an early (within 14 days) complication of AMI and is more common in anterior wall (4—12%) than in inferior wall infarction (1%). Approximately 40% of patients with an anterior wall myocardial infarction develop left ventricular thrombus. 

Our insight into the development, evolution and the mechanisms of damage in cerebral ischemia is mainly based on animal studies. A large variety of experimental models have been developed that imitate conditions of stroke and cardiac arrest (Hossmann 1991). In the past, experiments had to be terminated at certain timepoints to obtain invasive measurements of lesion size, blood flow, metabolism or other markers of injury. Therefore, longitudinal observations required large animal numbers and the inter-individual differences complicated the analysis of results. The advent of MR techniques of imaging... 

Index functional status 30 d after stroke. The results showed that only the severity of neurological deficit predicted greater 30-d mortality in these patients. Patients with hyperthermia on the first day of hospitalization had increased mortality and worse functional status at 30 d, but increased temperature was not an independent predictor of mortality 30 d after PICH. In a study to assess typical early onset complications following ischemic stroke, Weimar et al. (5) looked at a cohort of 3866 patients from 14 neurology departments with an acute stroke unit. In the first week following admission, increased intracranial pressure (ICP) and recurrent cerebral ischemia were the most frequent complications, along with fever, severe hypertension, and pneumonia. Similar concerns are also found in cardiac surgery patients in whom perioperative stroke occurred (6). 

Ruby RJ, Burton JR (1977). Acute reversible hemiparesis and hyponatremia. Lancet i 1212 Sabolek M, Bachus-Banaschak K, Bachus R et al. (2005). Multiple cerebral aneurysms as delayed complication of left cardiac myxoma a case report and review. Acta Neurology Scandinavica 111 345-350 Sacco RL, Kargman DE, Gu Q et al. (1995). Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study. Stroke 26 14-20 Salgado AV (1991). Central nervous system complications of infective endocarditis. 

Fever is unusual in the first few hours after stroke onset, and endocarditis or other infections, inflammatory vascular disorders or cardiac myxoma should be considered. Later fever is quite common and usually reflects a complication of the stroke (Ch. 16). 

Patients with atrial fibrillation or flutter may experience the entire range of symptoms associated with other supraventricular tachycardias, although syncope as a presenting symptom is uncommon. Since atrial kick is lost with the onset of atrial flbrillation, severe low-output states may result in forms of heart disease that rely heavily on atrial contraction to maintain cardiac output (such as mitral stenosis or hypertrophic obstructive cardiomyopathy see Chap. 18). An additional complication of atrial flbrillation is arterial embolization resulting from atrial stasis and poorly adherent mural thrombi. Of course, the most devastating complication in this regard is the occurrence of an embolic stroke. The overall incidence of stroke in patients with atrial... 

In a worldwide survey of AF ablation, major complications were reported in 6% of patients, including cardiac tamponade in 1.2%, stroke in 0.28% and transient ischemic attacks in 0.66% of left sided procedures (164). Periprocedural mortality was reported in 0.05%, Most thromboembolic strokes occur within two weeks of the ablation procedure (165). To reduce the risk of stroke, anticoagulation is often instituted prior to ablation, particularly in patients with CHADS-II risk factors (congestive heart failure or left ventricular dysfunction, hypertension,... 

Cardiac valves with components fabricated from low temperature isotropic carbons (pyrolytic carbon) are successfully used clinically [23]. These materials are appropriate for such applications as mechanical valves which require long-term chemical inertness, smoothness, and wear-resistance. The reasons for the marked improvement in the performance (reduced thrombosis and thromboembolic stroke rates) of these newer vs. older style heart valves are not entirely understood, but are undoubtedly multifactorial and related to improved patient management and valve design, as well as to the nature of the carbon surface. The specific benefits conferred by pyrolytic carbons with respect to blood cell and protein interactions, resulting in a very low frequency of clinical complications, remain to be defined. The use of carbon coatings has been proposed for other devices, i.e., vascular grafts, although such devices have not yet been used clinically. 

The toxicity of ephedrine is closely related to adverse cardiovascular events, since the clinical presentation of toxicity reflects the sympathomimetic activity of these agents. The adrenergic effects can shorten cardiac refractory periods, permitting the development of reentrant cardiac arrhythmias. The worst complication related to the use of ephedrine is thrombotic stroke, presumably resulting from vasoconstriction of large cerebral arteries that in turn leads to local thrombosis [71]. Other adverse effects include hypertension, diaphoresis, hypothermia, and agitation. The best treatment in an overdose is the rapid identification of the symptoms followed by supportive management. 

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