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Published in Clive Handler, Gerry Coghlan, Nick Brown, Management of Cardiac Problems in Primary Care, 2018
Clive Handler, Gerry Coghlan, Nick Brown
The incidence of atrial fibrillation increases with age, and the condition is common in patients aged over 70 years. Patients may experience ‘flutters’ in the chest. Paroxysmal atrial fibrillation may be detected on a 24-hour ECG recording, and patients may be symptom free.
Trans-catheter aortic valve implantation
Published in Ever D. Grech, Practical Interventional Cardiology, 2017
Didier Tchétché, Javier Molina Martin de Nicolas
A recent report from the France 2 registry, analysing 3191 patients, identified a stroke rate of 3.98% at 1 year: 55% were major strokes, 14.5% minor strokes, and 30.5% TIA. Fifty percent of strokes were peri-procedural, occurring within 2 days and related to technical issues, for example, complex procedures with several TAVI devices needed. Moreover, patients with stroke more frequently had new-onset paroxysmal atrial fibrillation. Stroke was associated to increased 1-year mortality without any difference according to access site or device type.36 Similarly, in the TVT registry, the incidence of stroke was 2.5% at 30 days and 4.1% at 1 year.21 The role of cerebral embolic protection devices to peri-procedural strokes is under investigation.37, 38 Optimal anticoagulant therapy may decrease stroke rates in the midterm vulnerability period.
Cerebrovascular Disease
Published in John W. Scadding, Nicholas A. Losseff, Clinical Neurology, 2011
In patients with suspected cardiogenic embolism, transthoracic echocardiography may define wall motion abnormalities or the presence of atrial or ventricular thrombus. Transthoracic echocardiography with injection of agitated saline and valsalva is now, in most hands, the optimal screening test for a patent foramen ovale. In selected patients, particularly younger patients with unexplained stroke, transoesophageal echocardiography should be performed because it provides better visualization than the transthoracic mode of aortic root disease and right to left shunts (e.g. patent foramen ovale). If cardiogenic embolus is still strongly suspected despite normal chest x-ray and ECG, then sometimes Holter monitoring may reveal paroxysmal atrial fibrillation. Holter monitoring may need to be prolonged in some cases (up to a week) to detect paroxysmal atrial fibrillation.
Obesity in acute ischaemic stroke patients treated with intravenous thrombolysis therapy
Published in Neurological Research, 2023
Hongmin Li, Suliman Khan, Rabeea Siddique, Qian Bai, Yang Liu, Ruiyi Zhang, Yan Zhang, V. Wee Yong, Mengzhou Xue
Atrial fibrillation and flutter allow blood to stagnate, particularly in the left atrial appendage, which can allow thrombosis and subsequent embolism to the cerebral or systemic circulation. Permanent and paroxysmal atrial fibrillation increases the risk of cardioembolic ischaemic stroke [19]. The prevalence of atrial fibrillation is increasing with the aging and increasingly obese population. In utero, the cardiac foramen ovale allows the flow of placental oxygenated blood from the right to the left atrium. After birth, the increase in pressure on the left side of the heart closes the flap in most people but about 25% of individuals have a degree of residual patency (PFO) [20]. This patency creates a potential mechanism for paradoxical embolism, which could lead to ischaemic stroke. The importance of PFO in young adult stroke has been highlighted by the significant reduction in the risk of recurrent ischaemic stroke after endovascular closure of PFO [20, 21]. Bacterial endocarditis can cause septic emboli in the brain, leading to ischaemic stroke. Also, bacterial endocarditis presents difficulties for stroke treatment as it is associated with an increased risk of haemorrhagic transformation after thrombolysis owing to septic arteritis that weakens vessel walls. Surveillance for mycotic aneurysms (infected aneurysms) should be considered, as they can occur after endocarditis and can rupture, causing subarachnoid haemorrhage or ICH. Regions of segmental hypokinesis within the heart can occur following myocardial infarction, which can predispose to cardioembolic stroke [22].
Electrocardiographic changes after breast reduction surgery
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Ayca Ergan Sahin, Tugce Yasak, Burak Yılmaz, Ahmet Anil Sahin, Ali Rıza Demir, Ozlem Colak
In literature, the relationship between atrial conduction and PWD was demonstrated in previous researches. Dilaveris et al. [16] compared patients with a history of paroxysmal atrial fibrillation to healthy controls and their study showed that paroxysmal atrial fibrillation patients had higher PWD than healthy controls. According to the studies in literature, Centurión commented that PWD was associated with an abnormality in atrial conduction, and increased PWD might lead to AF shortly [17]. In another study, patients with atrial fibrillation had similarities with patients who had PR interval prolongation and therefore, the authors commented that prolongation in PR interval might be considered as a preliminary stage to atrial fibrillation [18]. Additionally in a meta-analysis, Cheng et al. [19] concluded that, PR interval prolongation should not be considered as a benign condition but an independent risk factor for atrial fibrillation and atrial arrhythmogenesis. On the other hand, the parameters such as TPe duration, TPe/QT ratio and TPe/QTc ratio are used in the evaluation of ventricular repolarization and ventricular arrhythmogenesis [20,21]. Therefore, the improvement is these parameters might be a sign of decreased ventricular arrhythmogenesis and marker of improved ventricular conduction.
Assessment of patients with hereditary transthyretin amyloidosis – understanding the impact of management and disease progression
Published in Amyloid, 2019
Isabel Conceição, Teresa Coelho, Claudio Rapezzi, Yeşim Parman, Laura Obici, Lucía Galán, Antoine Rousseau
A 12-lead ECG to detect rhythm, QRS duration, QRS voltage, cQT, Q waves and ST abnormalities should be repeated on at least an annual basis. An annual Holter ECG should be used to search for rhythm and conduction disturbances and for the assessment of heart rate variability (in selected cases). The most relevant clinical implications are associated with the possible appearance of paroxysmal atrial fibrillation or advanced atrioventricular block. Echocardiography plays a major role in the non-invasive diagnosis of cardiac amyloidosis due to its assessment of structure and function. Myocardial thickness, biventricular systolic and diastolic circumferential and longitudinal function, parietal strain and strain rate can be easily evaluated at basal level and during follow-up. Nevertheless, variations in clinical status are rarely paralleled by changes in myocardial thickness. A restrictive transmitral Doppler pattern is a marker of disease severity, and its disappearance can be considered as a sign of haemodynamic improvement. Left ventricular (LV) ejection fraction is not a reliable marker of disease progression or regression in ATTR-CM. A recent prospective trial using tafamidis indicated that changes in LV strain measurements can parallel clinical improvements [38]. In a separate clinical trial using patisiran, improvements were observed in cardiac manifestations of ATTRv amyloidosis, as measured by LV strain, in a prespecified cardiac subpopulation with mixed phenotype [19].