Cardioembolic Stroke in Adults With a History of Congenital Heart Disease

Attar, Hatim; Sachdeva, Alok; Sundararajan, Sophia

doi:10.1161/strokeaha.116.012882

Cited by 11 publications

(15 citation statements)

References 10 publications

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“…CV disease can sometimes (indirectly) cause epilepsy through a predisposition to stroke [106,107]. Stroke is a common risk factor for epilepsy and accounts for about a third of newly diagnosed seizures in people over the age of 60 years [107][108][109][110].…”

Section: Resultant Aed ! Arrhythmias -Particularly Carbamazepine Phementioning

confidence: 99%

The heart of epilepsy: Current views and future concepts

Shmuely

Lende

Lamberts

et al. 2017

Seizure

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Cardiovascular (CV) comorbidities are common in people with epilepsy. Several mechanisms explain why these conditions tend to co-exist including causal associations, shared risk factors and those resulting from epilepsy or its treatment. Various arrhythmias occurring during and after seizures have been described. Ictal asystole is the most common cause. The converse phenomenon, arrhythmias causing seizures, appears extremely rare and has only been reported in children following cardioinihibitory syncope. Arrhythmias in epilepsy may not only result from seizure activity but also from a shared genetic susceptibility. Various cardiac and epilepsy genes could be implicated but firm evidence is still lacking. Several antiepileptic drugs (AEDs) triggering conduction abnormalities can also explain the co-existence of arrhythmias in epilepsy. Epidemiological studies have consistently shown that people with epilepsy have a higher prevalence of structural cardiac disease and a poorer CV risk profile than those without epilepsy. Shared CV risk factors, genetics and etiological factors can account for a significant part of the relationship between epilepsy and structural cardiac disease. Seizure activity may cause transient myocardial ischaemia and the Takotsubo syndrome. Additionally, certain AEDs may themselves negatively affect CV risk profile in epilepsy. Here we discuss the fascinating borderland of epilepsy and cardiovascular conditions. The review focuses on epidemiology, clinical presentations and possible mechanisms for shared pathophysiology. It concludes with a discussion of future developments and a call for validated screening instruments and guidelines aiding the early identification and treatment of CV comorbidity in epilepsy.

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Section: Resultant Aed ! Arrhythmias -Particularly Carbamazepine Phementioning

confidence: 99%

The heart of epilepsy: Current views and future concepts

Shmuely

Lende

Lamberts

et al. 2017

Seizure

View full text Add to dashboard Cite

show abstract

“…There are now over 1·4 million American adults with CHD, representing over two thirds of the total CHD population (3). Prevalence of ACHD is 6·16/1,000, and 0·68/1,000 for severe lesions (5–8, 20, 21). This represents a 63% increase over the last two decades (3), with further increases estimated at 1-5%/year (2, 22) (Figure 1).…”

Section: Epidemiology and Classification Of Chd And Changing Demograpmentioning

confidence: 99%

“…Adult CHD patients, in addition to having an increased risk of stroke related to the underlying structural cardiac issues (and associated dysrhythmias and coagulation abnormalities), may also have an accelerated burden of conventional vascular risk factors such as hypertension and impaired glucose metabolism (9, 20). The impact of these risk factors is increasingly significant as the lifespan of patients with ACHD continues to improve.…”

Section: Stroke In Achdmentioning

confidence: 99%

“…In many CHD lesion types, cardiac chambers are exposed to abnormal flow patterns and atypical pressure gradients. This is most often as a result of the chambers being exposed to pressures, or performing functions, which are otherwise atypical (12, 20, 30). For example, in Hypoplastic Left Heart Syndrome, the patient will have an anatomic right ventricle (which is usually a high volume-low pressure chamber) pumping against systemic vascular resistance.…”

Section: Stroke In Achdmentioning

confidence: 99%

“…These abnormal hemodynamic flow patterns and pressure gradients are present in the pre- and post-operative state, and can be extreme in palliated circulations (30). Pressure- and volume-loading of the cardiac chambers results in chamber dilatation and impaired mechanical function, leading to stasis and increased potential for thrombus formation (20). Pressure and volume stress can cause replacement fibrosis, with subsequent distortion of electrophysiologic chamber properties leading to dysrhythmias and conduction block (20, 40).…”

Section: Stroke In Achdmentioning

confidence: 99%

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Adults With Complex Congenital Heart Disease: Cerebrovascular Considerations for the Neurologist

et al. 2019

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As infant and childhood mortality has decreased in congenital heart disease, this population is increasingly reaching adulthood. Adults with congenital heart disease (ACHD) represent a group with increased risk of stroke, silent brain infarcts, and vascular cognitive impairment. Cyanotic and other complex cardiac lesions confer the greatest risk of these cerebrovascular insults. ACHD patients, in addition to having an increased risk of stroke from structural cardiac issues and associated physiological changes, may have an accelerated burden of conventional vascular risk factors, including hypertension and impaired glucose metabolism. Adult neurologists should be aware of the risks of clinically evident and subclinical cerebrovascular disease in this population. We review the existing evidence on primary and secondary stroke prevention in individuals with complex congenital heart disease, and identify knowledge gaps in need of further research, including treatment of acute stroke in this population. Multisystemic genetic syndromes are outside the scope of this review.

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Epilepsy and heart diseases

Shmuely

Thijs

2019

The Comorbidities of Epilepsy

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Cardioembolic Stroke in Adults With a History of Congenital Heart Disease

Cited by 11 publications

References 10 publications

The heart of epilepsy: Current views and future concepts

The heart of epilepsy: Current views and future concepts

Adults With Complex Congenital Heart Disease: Cerebrovascular Considerations for the Neurologist

Epilepsy and heart diseases

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