Cardiological pathology in patients with acute stroke: treatment and prevention of complications
Acute stroke remains one of the main causes of death and disability. The incidence of acute stroke is similar to the incidence of acute coronary syndrome, but the prognosis for the patient who suffered stroke is significantly worse. More and more scientific evidence confirms that at least 30-50 % (possibly more depending on the diagnostic approach) of ischemic strokes are caused by cardiac pathology (atrial fibrillation, of valvular heart diseaseor congenital heart disease, infective endocarditis, etc.). An even greater number of patients have concomitant cardiac pathology, which, if not the cause, worsens the course and prognosis of a patient with acute stroke. Therefore, it is important and relevant to determine the characteristics of these patients, taking into account the characteristics of comorbid pathology. It is important to cooperate with doctors of different specialties.
In the acute period of stroke there are specific tacticsand treatment patients with concomitant hypertension, atrial fibrillation and other cardiac pathologies. The tactics of a cardiologist depends on the type of stroke – ischemic or hemorrhagic. In patients with a stroke, it is important to determine the etiologic factor. In the presence of cardiac pathology, which is the cause of embolism, using of anticoagulants is the prevention of repeated strokes. Therefore, effective diagnosis and treatment of heart disease can significantly contribute to both stroke prevention and its prognosis.
The article reviews the literature on the problem of treatment cardiopathology in patients who suffered a stroke or a transient ischemic attack. The peculiarities of the treatment of hypertension in the acute period of stroke and the post-stroke period are considered; questions of statinotherapy. The principles of the using (start, initiation) of oral anticoagulants in atrial fibrillation in patients with acute stroke are discussed. Principles of prevention of stroke in atrial fibrillation and «triple» therapy (double antiplatelet plus oral anticoagulant) are described.
Clinical of neurosurgical help in patients with the consequences of ischemic stroke, with occlusions and stenoses of preecerebral and cerebral arteries, which do not cause the development of cerebral infarction. Order of the Ministry of Health of Ukraine N 317 13.06.2008 (Ukr).Ukrayinskij nejrohirurgichnij zhur- nal (Ukr). 2008;3 (43):78-9.
Nosenko NN, Babkina TM, Scheglov DV, Novikova MN. Cardiologist’s advises: Patients with stroke. Causes, methods of diagnosis, recommendations (Ukr). Endovascular Neuroradiol (Ukr). 2016; 4(18):18-27.
Kirchhof P, Benussi S, Kotecha D. et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. EHJ. 2016;37:2893-962. https://doi.org/10.1093/eurheartj/ ehw210.
Aboyans V, Ricco JB, Bartelink ML et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). EHJ. 2017. doi:10.1093/eurheartj/ehx095.
Amarenco P, Labreuche J. Lipid management in the prevention of stroke:review and updated meta-analysis of statins for stroke prevention. Lancet Neurol. 2009;8:453-63. doi: 10.1016/S1474-4422(09)70058-4.
Auer J, Huber K, Granger CB. Interruption of non-vitamin K antagonist anticoagulants in patients undergoing planned invasive procedures: how long is long enough? EHJ. 2017;38(31):2440-3. https://doi. org/10.1093/eurheartj/ehx416.
Chobanian AV Hypertension in 2017. What Is the Right Target? JAMA. 2017;317(6):579-80. doi:10.1001/ jama.2017.0105.
Derdeyn C.P, Zipfel GJ, Albuquerque FC. Management of Brain Arteriovenous Malformations: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2017. doi: STR.0000000000000134.
Ebrahim S, Sung J, Song YM. Serum cholesterol, haemorrhagic stroke, ischaemic stroke, and myocardial infarction: Korean national health system prospective cohort study [published correction appears in BMJ. 2006;333:468]. BMJ. 2006;333:22. doi: 10.1136/ bmj.38855.610324.80.
European Stroke Organisation. Guidelines for management of ischaemic stroke and transient ischaemic attack. 2008. Cerebrovasc Dis. 2008;25(5):457-507. doi: 10.1159/000131083.
Godier A, Dincq A, Martin A. Predictors of pre-procedural concentrations of direct oral anticoagulants: a prospective multicentre study. EHJ. 2017;38(31):2431- 9. https://doi.org/10.1093/eurheartj/ehx403.
Saric M, Armour A, Arnaout M. et al. Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism. JASE. 2016;29(1):1-42. doi: http://dx.doi.org/10.1016/j.echo.2015.09.011.
Hemphill JC, Greenberg SM, Anderson CS et al. AHA/ ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage. Stroke. 2015. doi: 10.1161/ STR.0000000000000069.
Iso H, Jacobs Jr, Wentworth D. Serum cholesterol levels and six-year mortality from stroke in 350,977 men screened for the Multiple Risk Factor Intervention Trial. N Engl J Med. 1989;320:904-10. doi: 10.1056/ NEJM198904063201405.
Jauch EC, Saver JL, Adams HP. AHA/ASA Guidelines for the Early Management of Patients With Acute Ischemic Stroke. Stroke. 2013;44:870-947. https://doi. org/10.1161/STR.0b013e318284056a.
Kernan WN, Ovbiagele B, Black HR. AHA/ASA Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack. Stroke. 2014;45:2160-236. https://doi.org/10.1161/ STR.0000000000000024.
Kirchhof P, Schroeder S et al. NOACs in Atrial Fibrillation. EHJ. 2017;38(31):2382-5. https://doi. org/10.1093/eurheartj/ehx407.
Lanzer P, Haude M, Widimsky P. Stroke management by cardiologists. EHJ. 2017;38(31): 2389-90. https:// doi.org/10.1093/eurheartj/ehx411.
Leppâlâ JM, Virtamo J, Fogelholm R. Different risk factors for different stroke subtypes: association of blood pressure, cholesterol, and antioxidants. Stroke. 1999;30:2535-40.
Lindbohm JV, Kaprio J, Korja M. Cholesterol as a risk factor for subarachnoid hemorrhage: a systematic review. PLoS One. 2016;11(4):e0152568. doi: 10.1371/ journal.pone.0152568.
Mancia G, Fagard R, Narkiewicz K. 2013 ESH/ESC Guidelines for the management of arterial hypertension. EHJ. 2013; 34:2159-219. doi:10.1093/eurheartj/ eht151.
Schneck MJ, Lei Xu Cardioembolic stroke. Med- scape. 2015. http://emedicine.medscape.com/article/1 160370-overview#a1.
Paciaroni M, Agnelli G, Micheli S, Caso V. Efficacy and safety of anticoagulant treatment in acute cardi- oembolic stroke: a meta-analysis of randomized controlled trials. Stroke. 2007;38:423-30.
Pepi M, Evangelista A, Nihoyannopoulos P. et al. Recommendations for echocardiography use in the diagnosis and management of cardiac sources of embolism. Eur J Echocardiogr. 2010; 11(6):461-76. doi:10.1093/ ejechocard/jeq045.
Samai AA, Martin-Schild S. Sex differences in predictors of ischemic stroke: current perspectives. Vasc Health Risk Manag. 2015; 11:427-36. doi: 10.2147/ VHRM.S65886.
Bushra S, Monaghan MJ et al. The pivotal role of echocardiography in cardiac sources of embolism. Eur. J. Echocardiogr. 2011;12:i25-31. https://doi.org/ 10.1093/ejechocard/jer122.
Widimsky P, Doehner W, Diener HC et al. The role of cardiologists in stroke prevention and treatment: position paper of the European Society of Cardiology Council on Stroke. EHJ. ehx478, https://doi. org/10.1093/eurheartj/ehx478/.
Valgimigli M, Bueno H, Byrne RA et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). EHJ. ehx419, https://doi.org/10.1093/eurheartj/ehx419.
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