The Effect of Acute Stroke on Cardiac Functions as Observed in an Intensive Stroke Care Unit

112

The physiological basis for the arrhythmias commonly observed after a stroke is not well understood. Based on evidence that the right and left cerebral hemispheres influence cardiac function in different ways, we sought to determine whether the nature and severity of cardiac arrhythmias in the context of an acute stroke vary in relation to whether the stroke is located in the left or the right hemisphere. Data were obtained from the medical records of nineteen patients with left hemisphere strokes and nineteen patients with right hemisphere strokes who had also had 24-hour electrocardiographic (Holter) recordings within 2 weeks of admission to a stroke unit. Written Holter monitor reports already on file were used for the data analysis. All four patients with supraventricular tachycardia had right hemisphere strokes (p = 0.05). There was a nonsignificant trend for left hemisphere stroke patients to have more severe ventricular arrhythmias. These data provide partial support for the hypothesis that the two cerebral hemispheres have a differential influence on the nature and severity of arrhythmias following an acute stroke. We speculate that parasympathetic tone was diminished ipsilateral to the affected hemisphere associated with a reciprocal rise in sympathetic tone on that side and recommend that a prospective study be undertaken to test this hypothesis more definitively.

Section: Background and Purposementioning

confidence: 72%

Supraventricular tachycardia in patients with right hemisphere strokes.

Lane

Wallace

Petrosky

et al. 1992

112

“…[15][16][17][18][19][20] The incidence rate of arrhythmias was reported in these studies with a remarkable high fluctuation, ranging from 31% to 87% of all patients. A number of factors may be responsible for the reported discrepancies: conflicting definition of arrhythmias as well as different techniques, duration, and different evaluation of cardiac monitoring.…”

Section: Incidence Of Serious Tachycardia and Bradycardiamentioning

confidence: 92%

“…In some studies, the diagnosis of stroke was established clinically in absence of CT scanning, because modern imaging techniques have not been generally available yet. 16,19 In addition, sinus tachycardia or isolated premature ventricular or supraventricular beats were reported as significant arrhythmia. However, recommendations on the treatment of asymptomatic premature beats have meanwhile been modified and urgent therapeutic intervention is no longer indicated in the majority of cases.…”

Section: Incidence Of Serious Tachycardia and Bradycardiamentioning

confidence: 99%

Serious Cardiac Arrhythmias After Stroke

Kallmünzer¹,

Breuer²,

Kahl³

et al. 2012

142

Background and Purpose-Patients with acute cerebrovascular events are susceptible to serious cardiac arrhythmias, but data on the time course and the determinants of their onset are scarce. Methods-The prospective Stroke-Arrhythmia-Monitoring-Database (SAMBA) assessed cardiac arrhythmias with need for urgent evaluation and treatment in 501 acute neurovascular patients during the first 72 hours after admission to a monitored stroke unit. Arrhythmias were systematically detected by structured processing of telemetric data. Time of arrhythmia onset and predisposing factors were investigated. Results-Significant cardiac arrhythmias occurred in 25.1% of all patients. Incidence was highest during the first 24 hours after admission. Serious arrhythmic tachycardia (ventricular or supraventricular >130 beats/min) was more frequent than bradycardic arrhythmia ( sinus-node dysfunction, bradyarrhythmia, or atrioventricular block °II and °III). Arrhythmias were independently associated with higher age and severer neurological deficits as measured by the National Institutes of Health Stroke Scale on admission. Conclusions-The risk for significant cardiac arrhythmia after an acute cerebrovascular event is highest during the first 24 hours of care and declines with time during the first 3 days. Along with established vascular risk factors, the National Institutes of Health Stroke Scale may be considered for a stratified allocation of monitoring capabilities.

“…One early study found that 67% of patients admitted to an intensive care stroke unit developed conduction or rhythm abnormalities on 24-hour monitoring, however this was a small study and included both ischemic and hemorrhagic strokes. 14 In a more recent larger study, ECG abnormalities were observed in 60% of patients with cerebral infarction. 15 In multivariate analyses of these patients, 3-month mortality was predicted by AF, atrioventricular block, ST-changes, and inverted T-waves independent of stroke severity, prestroke disability, and age.…”

Section: Telemetry Monitoringmentioning

confidence: 90%

Cardiac Workup of Ischemic Stroke

Morris

Duffis

Fisher

2009

Background and Purpose-Discovering potential cardiac sources of stroke is an important part of the urgent evaluation of the ischemic stroke patient as it often impacts treatment decisions that are essential for determining secondary stroke prevention strategies, yet the optimal approach to the cardiac workup of an ischemic stroke patient is not known. Methods-A review of the literature concerning the utility of cardiac rhythm monitoring (ECG, telemetry, Holter monitors, and event recorders) and structural imaging (transthoracic and transesophageal echocardiography) was performed. Results-Data supporting a definitive, optimal, and cost-effective approach are lacking, though some data suggest that appropriate patient selection can improve the diagnostic and therapeutic yield of rhythm monitoring and echocardiography in the evaluation of stroke etiology. Conclusions-Based on available data, an algorithmic approach for the evaluation of patients with acute ischemic cerebrovascular events that takes into account therapeutic and diagnostic yield as well as cost-efficiency is proposed.