Yield of Cardiac Investigations in Patients Presenting with Acute Ischaemic Stroke (original) (raw)
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Cardiac diagnostic work-up of ischaemic stroke
European Heart Journal, 2016
Cardioembolic sources account for 20-30% of ischaemic strokes and are important to identify considering their prognostic and therapeutic implications. During the past years, new developments have been made in the cardiac diagnostic evaluation and management of patients with ischaemic stroke, especially regarding strokes of unknown aetiology. These recent advances have had a major impact on our understanding of embolic strokes, their diagnostic work-up, and clinical management. Herein, we propose a cardiac diagnostic work-up scheme for patients with ischaemic stroke from definite cardioembolic sources and embolic strokes of undetermined source.
Objective: Whether or not patients of ischaemic stroke should undergo investigations for coronary artery disease (asymptomatic) is debatable yet scarcely ever have the risk of vascular death and myocardial infarction after a stroke been quantitatively evaluated. Immediately preceding the incidence of an acute stroke, a high risk of recurrence is seen yet the prime factor driving up mortality rates after a stroke is myocardial infarction and coronary artery disease. This paper hopes to indirectly assess the risk of schaemic heart disease in patients who have formerly faced episode(s) of acute ischaemic stroke. Methodology: A sample of consecutive 100 known cases of Myocardial Infarction presenting at Liaquat University Hospital, Department of Cardiology (Emergency and Out-Patient Department) was included in this retrospective quantitative analysis during the month of January 2016. After taking written informed consent, inquiries were made regarding previous incidences of ischaemic stroke (if any) and the time elapsed since the incident. Inquiries were also made regarding previous history of cardiac illness. The data obtained was analyzed using SPSS v. 17. Results: 60% of the sample comprised of males while 40% comprised of females, each with a mean age of 59 years and 65 years respectively. 20 out of a total of 100 patients presenting with Myocardial Infarction gave affirmative previous history of ischaemic stroke. 80% of the patients with a positive history of ischaemic stroke were males while the remaining 20% with a positive history were females. Conclusion : A careful evaluation of the results reveals that incidence of myocardial infarction among known patients of ischaemic stroke is worrisomely high. More worryingly the incidence is particularly higher in males as compared to females. Keywords: Ischaemic Stroke, Myocardial Infarction, Retrospective & Quantitative Analysis
Revista Espanola De Cardiologia, 2009
In patients with stroke, atrial fibrillation is an independent risk factor and indicates a poor prognosis. Cardiac monitoring is carried out for longer periods in stroke units. The aim of this study was to determine the frequency at which atrial fibrillation is detected in stroke units and the percentage of patients with acute ischemic stroke or transient ischemic attack who receive anticoagulant therapy.
The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 2018
Background: Acute ischemic stroke is one of the major causes of disability and death worldwide. Effective prevention remains the best approach for reducing the burden of stroke. The aim of this work was to study the prevalence of stroke risk factors and the possible relation between such risk factors and the disease severity at presentation in a sample of stroke patients presented to Beni-Suef University Hospital, north Upper Egypt. Methods: A sample of 167 patients of acute ischemic stroke recruited from Beni-Suef University Hospital was included in this cross-sectional descriptive study. All subjects were subjected to history taking, clinical, laboratory, and radiological evaluation. Stroke severity and disability were evaluated by National Institute of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) respectively. Results: Hypertension was detected in 104 patients (62.3%), dyslipidemia was detected in 79 patients (58.1%), and 69 patients (41.3%) were smokers. Diabetes mellitus was detected in 58 patients (34.7%) with high prevalence of cardio-embolic risk factor, 36 patients (21.6%) had rheumatic heart, and 44 patients (26.3%) had atrial fibrillation. NIHSS score was significantly higher in hypertensive patients (P value = 0.023) and in patients who had carotid stenosis ≥ 50% (P value = 0.011), whereas there was no significant relation between NIHSS score and diabetes mellitus (P = 0.221), dyslipidemia (P = 0.834), patients with history of cardio-embolic stroke (P = 0.085), previous ischemic stroke (P = 0.316), or sex (P = 0.343). mRS score was significantly higher in patients with age > 45 years old (P < 0.001), hypertension (P < 0.001), cardio-embolic risk factor (P = 0.044), and carotid stenosis ≥ 50% (P = 0.017), whereas there was no significant relation between mRS score and diabetes mellitus, previous ischemic stroke, or sex. Conclusions: The most common risk factor for stroke was hypertension followed by dyslipidemia and then smoking with higher incidence of rheumatic heart diseases due to lowered living conditions. Age, hypertension, cardio-embolic risk factors, and carotid stenosis ≥ 50% have negative impact on stroke severity and disability.
SAS Journal of Medicine, 2022
Background: Stroke is a worldwide growing health problem; a significant proportion of acute ischemic strokes occur as the first manifestation of atrial fibrillation. We sought to evaluate the performance of 24-hour rhythm monitoring in detecting paroxysmal atrial fibrillation. Methods: This was a cross-sectional study conducted at the University Hospital of Marrakech, in 174 selected patients with ischemic stroke without clear etiology at baseline subjected to ambulatory Holter monitoring. Results: The overall detection rate for atrial fibrillation was 4.1%, allowing the initiation of anticoagulant therapy in selected patients. Nevertheless, although some degree of success in detecting AF in a short period of monitoring was achieved, it is believed that the prevalence of AF is still underestimated by this screening modality. Conclusion: Tracking atrial fibrillation is a fundamental element in the secondary prevention of stroke; the development of new digital technologies now makes t...
Clinical Medicine, 2020
The incidence of acute ischaemic stroke in young patients is increasing and identifying the underlying cause is critically important with regards to their optimal management. The true proportion of cardiac causes of stroke in young patients is poorly defi ned. We aimed to determine the proportion of strokes attributable to cardiac causes in an unselected, consecutive cohort of young patients. We used the database of a large stroke service to identify patients aged ≤55 years presenting with stroke between 01 January 2015 and 31 December 2017. We reviewed their clinical notes and investigations and then categorised patients by the cause of their stroke. We screened 202 cases, and excluded 35, resulting in a study population of 167 patients; 24.0% (40/167) had a cardiac cause of stroke including 9.6% (16/167) had patent foramen ovale, 9.0% (15/167) had intracardiac source of embolus and 5.4% (9/167) had atrial fi brillation; 50.8% (85/167) had other more likely causes; and 25.1% (42/167) had no clear underlying cause. A high proportion (24%) of strokes in young patients are secondary to a cardiac cause. Thorough investigation in these patients is warranted and requires close interdisciplinary links between cardiologists and stroke physicians to ensure optimal management.
Low prevalence of atrial fibrillation in ischaemic stroke: Underestimating a modifiable risk factor
African Journal of Emergency Medicine, 2021
Introduction: Cerebrovascular disease remains one of the leading causes of morbidity and mortality globally. In South Africa, it was the fourth leading cause of death in 2016, responsible for 5.1% of all deaths-the leading cause of death in individuals 65 years and older. Atrial fibrillation accounts for 15% of all strokes and 25% are diagnosed when patients present with a stroke. We set out to determine the prevalence of atrial fibrillation in patients with confirmed ischaemic strokes in a district level hospital in the Western Cape, South Africa. Methods: This descriptive study was conducted at Mitchells Plain Hospital in Cape Town and data was collected over a one-year period. Patients diagnosed with a stroke were identified from an electronic patient register and relevant radiology and clinical data were sourced retrospectively. The diagnosis of ischaemic stroke was confirmed by a CT scan report and ECGs were independently screened by two Emergency Physicians. Ethical approval was granted by the University of Cape Town Human Research Ethics Committee [790/2018]. Results: The proportion of adult patients with a stroke diagnosis was 2%. Of the included cases, 80% had ischaemic strokes and 11% had haemorrhagic strokes. 11% of all patients with ischaemic strokes had atrial fibrillation, 67% of those presumed new. A total of 60 (15%) of all patients with ischaemic stroke were aged 45 years or younger. The inpatient mortality rate was statistically higher in patients who had atrial fibrillation (26% vs 7%, p < 0.001). Conclusion: With the increasing population life expectancy, and prevalence of cardiovascular disease the prevalence of atrial fibrillation and its complications will increase. Since the risk of stroke related to atrial fibrillation can be reduced significantly by oral anticoagulation, further studies should aim to explore barriers and challenges to effective screening. African relevance • The 11% prevalence of atrial fibrillation (AF) in ischaemic stroke is an underestimation of a modifiable risk factor. • 67% of AF was newly diagnosed, reflecting ineffective primary and secondary screening practices. • Patients with AF related stroke have worse outcomes with a 26% prevalence of inpatient mortality. • With the increasing population life expectancy, the prevalence of AF and its complications is expected to increase.
Electrocardiographic changes in patients with ischaemic stroke and their prognostic importance
International journal of clinical practice, 2004
We investigated prognostic importance of electrocardiographic (ECG) changes in ischaemic stroke patients without primary heart disease because of the limited evidence. This study consisted of 162 patients (92 male, age 64 +/- 14 years) with first ischaemic stroke presenting to hospital during 18 months. One-month mortality was analysed by means of ischaemia-like ECG changes, long QT and arrhythmia. Ischaemia-like ECG changes were observed in 79% of stroke patients and long QTc in 26% and arrhythmias in 44%. Early mortality rate was 27% (n = 44). Age, ST-segment change and abnormal U wave were univariate predictors of early mortality (each p < 0.05). In multivariate analysis, age > 65 years (OR = 1.4, p = 0.02) and presence of ST-segment change (OR = 2.6, p = 0.01) were only independent predictors. Although sensitivity and specificity of ST-segment change were relatively low to identify patients at risk of death, its negative predictive value was 82%. The ECG changes are freque...