Some of the cardiac causes for stroke are explained below:

Myocardial infarction

Stroke is an important complication in patients with Acute Myocardial Infarction (AMI). Most strokes occur in the first weeks after the infarct, but some risk for stroke remains for an indefinite time.

Atrial fibrillation

Atrial fibrillation increases the risk of thromboembolism up to 18 times. Autopsy data indicate that stroke is a possibility throughout the life of persons with a history of atrial fibrillation. Duration of atrial fibrillation has not correlated with risk.

In a patient with atrial fibrillation who has acute stroke, recurrent stroke risk may be particularly high during the first week or two after the acute infarction.

Valvular disease

Ischemic stroke is a well known complication of cardiac valvular pathology. Its mechanism is generally accepted to be an embolism from the diseased native valve or the prosthetic valve that replaced it.

Native valves

Of mitral and aortic valve disorders, rheumatic mitral stenosis is the most common associated with thromboembolism, irrespective of the coexistence of mitral regurgitation.

Mitral Valve Prolapse (MVP)

Patients with MVP who are asymptomatic are not necessarily candidates for antithrombotic or anticoagulant agents. Those who have suffered ischemic brain events should be given prophylactic medication. Antiplatelet agents are used for MVP.

Prosthetic heart valves

Diseased heart valves are replaced with either mechanical or bioprosthetic (tissue) valves. Tissue prosthetic valves are believed to be associated with a smaller risk of thromboembolism than mechanical valves. Mitral valve prostheses are associated with a greater risk of thromboembolism, possibly because of the higher incidence of atrial fibrillation and other thromboembolic risk factors in these patients.

Repaired cardiac valves

Surgical repair of mitral valves for mitral insufficiency has been reported to be longer lasting and to have lower morbidity and mortality and lower incidence of thromboembolism than valvular replacement. Despite all precautions, the risk of stroke is approximately 2%.

Embolism of aortic arch origin

Complicated atherosclerotic plaques of the aortic arch constitute a source of atherothrombolic or cholesterol embolism. Transesophageal Echocardiography (TEE) allows detection of plaques in the aortic arch. TEE is accurate, safe, and well tolerated for examination of the aortic arch, even in patients older than 85 years.

Patent foramen ovale

It is not known if the stroke rate is dependent on characteristics of the patent foramen ovale, eg, size, spontaneous shunting, and shunting with Valsalva maneuver . The diagnosis of a patent foramen ovale may be suspected in any stroke patient.

Large artery atherosclerotic plaque

Artery-to-artery embolism is thought to be the most common cause of cerebral infarction associated with plaques of the large cerebral arteries. Embolic infarcts associated with these plaques usually involve the middle and posterior artery territories and vary in size.

Vasculitis

Inflammatory conditions can involve the cerebral vasculature. Their causes are poorly understood, and the bedside diagnosis is problematic for lack of an accurate noninvasive test and the relatively nonspecific nature of clinical manifestations.

An inflammatory infiltration of the arterial wall can be seen in patients with bacterial or tuberculous meningitis, cerebral cysticercosis, fungal infection, and herpes zoster arteritis. Diagnosis and treatment are specific for each instance.

Small artery occlusion

Small, deep cavitary infarcts are mainly due to small arterial occlusions. Neuroimaging and pathology indicate a continuum of cerebral histological alteration due to small artery ischemia ranging from an isolated focal loss of neurons to cavitary infarction with loss of all tissue elements.

Intrinsic small artery disease

This condition is dominantly inherited from the genes. Small granular arteriopathy associated with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy is responsible for both ischemic rarefaction and small, deep cavitary infarcts.

Prothrombotic states

Primary prothrombotic states include abnormalities of certain hemostatic regulatory proteins. Genetic defects of the regulatory hemostatic proteins that produce prothrombotic states usually present clinically with thrombotic episodes by the second or third decade of life, whereas acquired deficiencies in these hemostatic proteins may be associated with stroke at any age.

Recommendations

• Patients with myocardial infarction at high risk for systemic embolization should receive oral anticoagulation for 6 months or more.
• Patients with cardiac valvular disorders, prosthetic heart valves, and repaired valves have a variable risk of ischemic stroke. Their need for antiplatelet or anticoagulant therapy should be evaluated.
• Carotid endarterectomy is beneficial for patients with recent cerebral ischemia and ipsilateral (nonocclusive) carotid artery stenosis of >70%. It is not beneficial for patients with 0% to 29% stenosis, and it remains uncertain if endarterectomy is beneficial for stenosis of 30% to 69%.
• The etiology (hemorrhage, ischemia versus non-stroke-related potential causes) of transient cerebral symptoms should be diagnosed in every patient who experiences them.
• Ticlopidine is more effective than aspirin, but the cost and risk of adverse effects are higher.

Related Articles

• Is Stroke Worse than a Heart Attack?
• Rehabilitation may begin within two days after the stroke
• Behavioral and Emotional Changes after Stroke
• Recent Facts in Treatment and Research of Stroke.