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Yang H, Nassif M, Khairy P, de Groot JR, Roos YBWEM, de Winter RJ, Mulder BJM, Bouma BJ. Cardiac diagnostic work-up of ischaemic stroke. Eur Heart J 2019; 39:1851-1860. [PMID: 29788298 DOI: 10.1093/eurheartj/ehy043] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/17/2016] [Indexed: 12/20/2022] Open
Abstract
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.
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Affiliation(s)
- Hayang Yang
- Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Interuniversity Cardiology Institute of the Netherlands-Netherlands Heart Institute, Moreelsepark 1, 3511 EP, Utrecht, The Netherlands
| | - Martina Nassif
- Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Paul Khairy
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, 5000 Rue Bélanger, QC H1T 1C8, Montreal, Canada
| | - Joris R de Groot
- Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Yvo B W E M Roos
- Department of Neurology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Robbert J de Winter
- Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Barbara J M Mulder
- Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Interuniversity Cardiology Institute of the Netherlands-Netherlands Heart Institute, Moreelsepark 1, 3511 EP, Utrecht, The Netherlands
| | - Berto J Bouma
- Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Fernando RJ, Goeddel LA, Shah R, Ramakrishna H. Analysis of the 2019 ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS Appropriate Use Criteria for Multimodal Imaging in the Assessment of Structural Heart Disease. J Cardiothorac Vasc Anesth 2019; 34:805-818. [PMID: 31196720 DOI: 10.1053/j.jvca.2019.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 05/15/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Rohesh J Fernando
- Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC
| | - Lee A Goeddel
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Ronak Shah
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, Philadelphia, PA
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ.
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3
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Alkuwaiti FA, Elghoneimy Y, Ghazal S. Aortic Valve Myxoma Presenting with a Stroke: A case report and review of the literature. Sultan Qaboos Univ Med J 2019; 18:e537-e540. [PMID: 30988977 DOI: 10.18295/squmj.2018.18.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 07/25/2018] [Accepted: 08/09/2018] [Indexed: 12/26/2022] Open
Abstract
Myxomas originating from the aortic valve are rare. We report a 40-year-old male patient who presented to the King Fahd Hospital of the University, Khobar, Saudi Arabia, in 2017 with a stroke. Transoesophageal echocardiography indicated a mobile mass measuring 6 × 2 mm attached to the right coronary cusp of the aortic valve and a mobile interatrial septum with a small patent foramen ovale (PFO). The patient underwent surgical excision of the mass and direct closure of the PFO. Histopathology confirmed the mass to be a myxoma. Despite their rarity, the recognition and treatment of valvular myxomas is very important; moreover, clinicians should be aware that affected patients may present with an embolic stroke.
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Affiliation(s)
- Feras A Alkuwaiti
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Yasser Elghoneimy
- Department of Surgery, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sami Ghazal
- Department of Internal Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Landry GJ, Shukla R, Rahman A, Azarbal AF, Mitchell EL, Liem TK, Moneta GL. Demographic and echocardiographic predictors of anatomic site and outcomes of surgical interventions for cardiogenic limb emboli. Vasc Med 2016; 21:528-534. [PMID: 27807307 DOI: 10.1177/1358863x16666691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We sought to determine if symptomatic cardiogenic limb emboli have a random distribution or if there are demographic or echocardiographic factors that predict site of embolization, limb salvage and mortality. Upper (UE) and lower extremity (LE) emboli were evaluated over a 16-year period (1996-2012). Demographic (age, gender, smoking, medical comorbidities) and echocardiographic data were analyzed to determine predictors of embolic site. All symptomatic patients underwent surgical revascularization. Limb salvage and mortality were compared with Kaplan-Meier analysis. A total of 161 patients with symptomatic cardiogenic emboli were identified: 56 UE and 105 LE. The female-to-male ratio for UE emboli (70%:30%) was significantly higher than for LE emboli (47%:53%, p=0.008). No other demographic factors were statistically different. Upper extremity patients were more likely to have atrial fibrillation (50% vs 29.8%, p=0.028), while LE patients had a higher percentage of aortic or mitral valvular disease or intracardiac thrombus (71.4% vs 52.5%, p=0.038). The 30-day limb salvage was higher for UE compared to LE (100% vs 88%, p=0.008). There was a trend toward higher 30-day mortality in the LE group (14% vs 5%, p=0.11). Survival at 1, 3, and 5 years were similar (UE: 62.2%, 44.2%, 35.3%; LE: 69.1%, 47.5%, 30.3%; p=ns). Upper extremity emboli are more frequent in women and patients with atrial fibrillation. Lower extremity emboli are more frequent in the presence of valvular disease or intracardiac thrombus, and are associated with increased 30-day limb loss and mortality. These findings suggest gender- and cardiac-specific differences in patterns of blood flow leading to preferential sites of peripheral embolization.
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Affiliation(s)
- Gregory J Landry
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Rakendu Shukla
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Auddri Rahman
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Amir F Azarbal
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Erica L Mitchell
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Timothy K Liem
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Gregory L Moneta
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
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5
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Testuz A, Noble S. Mobile debris in the aorta. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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6
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Rajani AR, Hussain K, Baslaib FO, Radaideh GA. A unique presentation of four thrombotic events at a time. BMJ Case Rep 2012. [PMID: 23188853 DOI: 10.1136/bcr-2012-007221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 72-year-old man was referred to our hospital as a case of postcardiac arrest following a long distance air flight. Work-up in the emergency department revealed the presence of deep vein thrombosis (DVT), bilateral pulmonary embolism, inferior STEMI (ST elevation myocardial infarction) and ischaemic stroke. He received thrombolysis by recombinant tissue plasminogen activator (tPA) following which his haemodynamic status improved, but he developed haemorrhagic transformation of the stroke as a complication. The haemorrhagic lesion gradually resolved with conservative management, leaving behind a residual neurological deficit. His haemodynamic status was stable after the management. Although a diagnosis of right-to-left shunt lesion was highly suggestive in this condition, it could not be confirmed on the transthoracic echocardiogram. Our patient had a unique presentation of multiple thrombi in different organs that caused significant morbidity and haemodynamic instability. There are no well-established guidelines that discuss the acute management of such cases. This situation requires a careful assessment and management of the patient by a multidisciplinary team.
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Affiliation(s)
- Ali Raza Rajani
- Department of Cardiology, Rashid Hospital, Dubai Health Authority, United Arab Emirates.
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