Abstract:
:Cryptogenic stroke (CS) accounts for 20% to 40% of ischemic strokes. CS is defined as a cortical infarct suggestive of an embolic stroke with no identifiable cardiac etiology, large vessel occlusive disease, or small vessel lacunar stroke. The likely etiologies for CS are patent foramen ovale (PFO) and paroxysmal atrial fibrillation, which can be detected by transesophageal echocardiography and long-term cardiac rhythm monitoring. In a busy academic hospital, the stroke service is frequently asked to provide a rational approach to patients with such a presentation. The 2011 American Heart Association/American Stroke Association recommends that antiplatelet therapy is "reasonable" (Class IIa; Level of Evidence B) for patients with PFO and a clinical presentation of CS. Confounding PFO management is the lack of a controlled trial comparing anticoagulation with antiplatelet therapy in patients with CS, despite the belief that the primary mechanism of PFO-mediated stroke would be that it serves as a conduit for venous emboli. Data from 3 recent prospective PFO closure device trials further compound the management protocols for these patients. Also complicating the management of CS is increasing evidence that paroxysmal atrial fibrillation may be found as often as 30% with extensive monitoring and long-term follow-up of 36 months. Based on these recent developments, we summarize the factors that we deemed relevant in our approach to patients with CS.
journal_name
Cardiol Revjournal_title
Cardiology in reviewauthors
Marks SJ,Khera Sdoi
10.1097/CRD.0000000000000073subject
Has Abstractpub_date
2016-07-01 00:00:00pages
153-7issue
4eissn
1061-5377issn
1538-4683journal_volume
24pub_type
杂志文章,评审abstract::About 50 years ago, Norman Jefferis Holter invented a device that opened the possibility of recording heart activity over long periods of time. This invention, together with the rapid developments in electronics, has enabled a revolutionary change in the diagnosis and management of cardiac diseases. Ambulatory cardiac...
journal_title:Cardiology in review
pub_type: 历史文章,杂志文章,评审
doi:10.1097/CRD.0b013e31828a8294
更新日期:2013-09-01 00:00:00
abstract::A decision-tree analysis was used to estimate the average cost per patient using the direct thrombin inhibitor argatroban for early treatment (<48 hours after thrombocytopenia onset) compared with delayed treatment (> or =48 hours after thrombocytopenia onset) of immune-mediated heparin-induced thrombocytopenia (HIT) ...
journal_title:Cardiology in review
pub_type: 杂志文章
doi:10.1097/01.crd.0000164011.17381.6f
更新日期:2006-01-01 00:00:00
abstract::Magnesium, the fourth most abundant cation in the human body, is involved in several essential physiological, biochemical, and cellular processes regulating cardiovascular function. It plays a critical role in modulating vascular smooth muscle tone, endothelial cell function, and myocardial excitability and is thus ce...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0000000000000003
更新日期:2014-07-01 00:00:00
abstract::Heart valve prostheses carry a risk for thrombosis and require an antithrombotic strategy to prevent stroke, systemic embolism, and prosthetic valve thrombosis. Contemporary randomized trials to guide the clinician on the optimal anticoagulant treatment are scarce, and the validity of the historical data for current r...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0b013e3182638578
更新日期:2013-01-01 00:00:00
abstract::There is a sexual dimorphism in blood pressure: men tend to have higher blood pressures than women with functional ovaries, whereas ovariectomy or menopause tends to abolish the sexual dimorphism and cause women to develop a "male" pattern of blood pressure. Synthetic estrogens and progestins, found in oral contracept...
journal_title:Cardiology in review
pub_type: 杂志文章
doi:10.1097/00045415-199811000-00012
更新日期:1998-11-01 00:00:00
abstract::Pulmonary artery hypertension (PAH) is a sequela of a number of disparate diseases, often with a fatal consequence. Endothelial dysfunction is considered to be an early event during the development of PAH. Impaired availability of bioactive nitric oxide (NO) is a key underlying feature in most forms of clinical and ex...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/01.crd.0000249381.49138.b9
更新日期:2007-05-01 00:00:00
abstract::Intravascular ultrasound imaging is a relatively new imaging modality that uses miniaturized ultrasound transducers, which are mounted on catheter tips and introduced into the vessel lumen to provide cross-sectional images of the vascular structure in real time. It has gained popularity rapidly among interventional ca...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/00045415-199909000-00014
更新日期:1999-09-01 00:00:00
abstract::The toll-like receptors (TLRs) are a class of transmembrane molecules that have important functions in both innate and acquired immunity. As part of the body's normal immune defense against microbial pathogens, stimulation of these receptors will trigger the inflammatory response cascade and the release of cytokines. ...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0b013e3181709fd8
更新日期:2008-11-01 00:00:00
abstract::Inappropriate sinus tachycardia (IST) is an uncommon form of arrhythmia characterized by an increased heart rate that is out of proportion to a normal physiologic demand. The etiology of IST remains ill-defined and controversial. Clinical presentation of IST is highly variable, from isolated to sustained palpitations,...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0b013e31822f0b3e
更新日期:2012-01-01 00:00:00
abstract::Computed tomography is an established tool in the assessment of cardiac anatomy and function. As demonstrated by single photon emission computed tomography, positron emission tomography, and magnetic resonance, the noninvasive evaluation of coronary hemodynamics is an important step in guiding clinical management. Nev...
journal_title:Cardiology in review
pub_type: 杂志文章
doi:10.1097/CRD.0000000000000242
更新日期:2019-07-01 00:00:00
abstract::Hypertrophic cardiomyopathy (HCM) is a heart disease characterized by hypertrophy of the left ventricular myocardium and is most often caused by mutations in sarcomere genes. The structural and functional abnormalities are not explained by flow-limiting coronary artery disease or loading conditions. The disease affect...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0000000000000184
更新日期:2018-05-01 00:00:00
abstract::Vitamin K antagonists (VKAs) such as warfarin have traditionally been the major therapeutic option for anticoagulation in clinical practice. VKAs are effective and extensively recommended for the prevention of venous and arterial thromboembolism in cardiovascular disease. Despite its effectiveness, warfarin is limited...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0b013e3182503e2d
更新日期:2012-09-01 00:00:00
abstract::Cholesterol metabolism and transport has been a major focus in cardiovascular disease risk modification over the past several decades. Hydroxymethylglutaryl-CoA reductase inhibitors (statins) have been the most commonly used agents, with the greatest benefit in reducing both the primary and secondary risks of cardiova...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0000000000000245
更新日期:2019-09-01 00:00:00
abstract::The effect of an ongoing educational program on the use of cardiovascular drugs in patients with coronary artery disease without contraindications to these drugs seen in an academic cardiology clinic was assessed in 100 patients seen during the 6-month period prior to the educational program and in 200 patients seen 9...
journal_title:Cardiology in review
pub_type: 杂志文章
doi:10.1097/01.crd.0000131191.57664.e7
更新日期:2005-03-01 00:00:00
abstract::Patients living with the human immunodeficiency virus (HIV) are at risk for dyslipidemia as a result of the disease itself and from certain classes of antiretroviral therapy. The protease inhibitors and non-nucleoside reverse transcription inhibitors have been associated with elevated triglycerides, total, and low-den...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0b013e3181903b7f
更新日期:2009-01-01 00:00:00
abstract::The obesity epidemic has reached unprecedented proportions in Western society. Evidence continues to accumulate that obesity is associated with significant morbidity and mortality and in particular that it is an independent risk factor for cardiovascular disease (CVD). The association of obesity with CVD and its risk ...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/00045415-200107000-00005
更新日期:2001-07-01 00:00:00
abstract::Endothelin is a potent vasoconstrictor substance that also can exert proliferative, inflammatory, and fibrotic changes in blood vessels and other organs. It acts on tissues in a paracrine and autocrine fashion, with local production and regulation occurring in both endothelial and nonendothelial cells. Endothelin stim...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0b013e3181aa8f4a
更新日期:2009-07-01 00:00:00
abstract::Underlying causes, risk factors, and precipitating causes of heart failure (HF) should be treated. Drugs known to precipitate or aggravate HF such as nonsteroidal antiinflammatory drugs should be stopped. Patients with HF and a low left ventricular ejection fraction (systolic heart failure) or normal ejection fraction...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/01.crd.0000175289.87583.e5
更新日期:2006-05-01 00:00:00
abstract::Inflammatory cardiomyopathy is a broad term encompassing any disease leading to myocardial inflammation with associated cardiac dysfunction. While endomyocardial biopsy remains the gold standard for diagnosis, non-invasive imaging techniques, such as cardiac magnetic resonance imaging and positron emission tomography,...
journal_title:Cardiology in review
pub_type: 杂志文章
doi:10.1097/CRD.0000000000000369
更新日期:2020-11-02 00:00:00
abstract::Cardiac allograft vasculopathy (CAV), characterized by diffuse intimal thickening and luminal narrowing in the arteries of the allograft, is the leading cause of morbidity and mortality in cardiac transplant recipients. Many transplant centers perform routine annual surveillance coronary angiography. However, angiogra...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0b013e3181fbde2f
更新日期:2011-01-01 00:00:00
abstract::Short QT syndrome is a rare inherited autosomal dominant cardiac channelopathy associated with malignant ventricular and atrial arrhythmias. A shortened corrected QT interval is a marker for risk of malignant arrhythmias, which are secondary to increased transmural dispersion of repolarization. The underlying gain of ...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0000000000000091
更新日期:2016-07-01 00:00:00
abstract::Despite recent advances in the management of chronic heart failure (CHF), the prognosis of many of these patients remains dire. The need for an accurate prognosis in these patients has led to the identification of several indicators purported to represent the impact of the disease. Such indicators often are obtained a...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0b013e3181c4ae0c
更新日期:2010-07-01 00:00:00
abstract::Radiation-induced heart disease (RIHD) is becoming an increasing concern for patients and clinicians alike as the use of radiation therapy for the treatment of certain malignancies increases, and patient mortality secondary to neoplasms of the thorax, in particular Hodgkin's lymphoma and breast cancer, decreases. The ...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0b013e3182431c23
更新日期:2012-07-01 00:00:00
abstract::Spontaneous nontraumatic intracerebral hemorrhage is associated with high morbidity and mortality. Given the risk of rapid neurological deterioration, early identification with rapid neuroimaging is vital. Predictors of outcome, such as spot sign and intracerebral hemorrhage score, can help guide management goals. Man...
journal_title:Cardiology in review
pub_type: 杂志文章
doi:10.1097/CRD.0000000000000332
更新日期:2021-01-01 00:00:00
abstract::Numerous investigators have attempted to target the natriuretic peptide system in the treatment of heart failure since it was first described over 30 years ago. The history of neprilysin inhibition as a treatment for heart failure has been characterized by numerous setbacks. Recently, the PARADIGM-HF trial has shown f...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0000000000000169
更新日期:2017-11-01 00:00:00
abstract::This literature review examines the association of social and psychologic characteristics among women with a) the risk of developing coronary heart disease and b) prognosis and recovery after disease has become manifest. Studies of psychosocial risk factors are often conflicting. These divergent findings can result fr...
journal_title:Cardiology in review
pub_type: 杂志文章
doi:
更新日期:1998-05-01 00:00:00
abstract::Myocarditis represents a heterogeneous final common pathway for myocardial inflammation of diverse etiologies and accounts for up to one-third of cases of dilated cardiomyopathy. The pathophysiology of viral myocarditis can be disaggregated into the effects of direct viral mediated injury, triggered acute and chronic ...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0b013e31806450c4
更新日期:2007-07-01 00:00:00
abstract::In 1992, Brugada and Brugada reported a distinct subgroup of patients with episodes of "idiopathic"polymorphic ventricular tachycardia or ventricular fibrillation characterized by a unique electrocardiographic (ECG) pattern, which consisted of right bundle branch block and ST-segment elevation from V1 to V2-V3. As in ...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/00045415-199907000-00010
更新日期:1999-07-01 00:00:00
abstract::Loop diuretics are central to the management of fluid overload in acute decompensated heart failure. However, a variance in the response to loop diuretics can alter a patient's clinical course and has an adverse effect on clinical outcomes. Thus, a diminished response to loop diuretics is an important clinical issue. ...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0000000000000116
更新日期:2016-09-01 00:00:00
abstract::Ayurveda is derived from 2 Sanskrit words, namely, "Ayus" and "Veda," meaning life and knowledge, respectively. It literally means science of life. Ayurveda, of which yoga is an integral part, is widely practiced in India and is gaining acceptance in many countries around the world. It is a comprehensive and a holisti...
journal_title:Cardiology in review
pub_type: 杂志文章
doi:10.1097/01.crd.0000128730.31658.36
更新日期:2004-09-01 00:00:00