HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wilterdink, J. L. Articles by Easton, J. D. Search for Related Content PubMed PubMed Citation Articles by Wilterdink, J. L. Articles by Easton, J. D.

Cardiac evaluation of stroke patients

From the Department of Clinical Neurosciences (Drs. Wilterdink and Easton), Brown University School of Medicine, Providence, RI, and the Department of Neurology (Dr. Furie), Harvard Medical School, Cambridge, MA.

Address correspondence and reprint requests to Dr. Janet L. Wilterdink, Department of Clinical Neurosciences, Brown University School of Medicine, 110 Lockwood Street, #324, Providence, RI 02903.

Abstract.

There are two potential purposes for cardiac evaluation in patients with cerebrovascular disease: to identify possible cardioembolic pathophysiology for ischemic symptoms and to identify concomitant coronary artery disease. Both have important implications for patient prognosis and treatment, and testing therefore appears to be warranted. On the other hand, the cost conservation movement in medicine dictates that physicians limit unnecessary, costly, possibly risky testing when the diagnostic yield is low. For example, the overall yield of cardiac testing in "usual stroke patients" who have no suggestive history or findings on examination, chest X-ray, or electrocardiogram is less than 10% and may not be indicated routinely. Conversely, young patients with stroke of unknown cause are likely to benefit from aggressive cardiac testing. Many reported series and clinical trials have demonstrated that patients with cerebrovascular disease are more likely to die in follow-up from cardiovascular than from cerebrovascular causes. This risk is best defined and may be highest in patients with carotid disease, in whom the 5-year cardiac mortality rate may be as high as 40 to 50%. Studies have shown that such patients are also likely to have abnormal tests for cardiac ischemia, even when a history of cardiovascular events or symptoms or electrocardiographic abnormalities are lacking. These results, combined with further investigations into which cerebrovascular patients are at highest risk for cardiovascular disease and what testing best identifies underlying, treatable cardiovascular disease, are needed to direct the care and improve the cardiovascular prognosis of patients with cerebrovascular disease.

This article has been cited by other articles:

				M. S. Dhamoon, W. Tai, B. Boden-Albala, T. Rundek, M. C. Paik, R. L. Sacco, and M. S.V. Elkind Risk of Myocardial Infarction or Vascular Death After First Ischemic Stroke: The Northern Manhattan Study Stroke, June 1, 2007; 38(6): 1752 - 1758. [Abstract] [Full Text] [PDF]

				Ph. G. Steg, D. L. Bhatt, P. W. F. Wilson, R. D'Agostino Sr, E. M. Ohman, J. Rother, C.-S. Liau, A. T. Hirsch, J.-L. Mas, Y. Ikeda, et al. One-Year Cardiovascular Event Rates in Outpatients With Atherothrombosis JAMA, March 21, 2007; 297(11): 1197 - 1206. [Abstract] [Full Text] [PDF]

				B. Fletcher, K. Berra, P. Ades, L. T. Braun, L. E. Burke, J. L. Durstine, J. M. Fair, G. F. Fletcher, D. Goff, L. L. Hayman, et al. Managing Abnormal Blood Lipids: A Collaborative Approach Circulation, November 15, 2005; 112(20): 3184 - 3209. [Abstract] [Full Text] [PDF]

				K. D. Flemming and R. D. Brown Jr Secondary Prevention Strategies in Ischemic Stroke: Identification and Optimal Management of Modifiable Risk Factors Mayo Clin. Proc., October 1, 2004; 79(10): 1330 - 1340. [Abstract] [PDF]

				R. J. Adams, M. I. Chimowitz, J. S. Alpert, I. A. Awad, M. D. Cerqueria, P. Fayad, and K. A. Taubert Coronary Risk Evaluation in Patients With Transient Ischemic Attack and Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/American Stroke Association Circulation, September 9, 2003; 108(10): 1278 - 1290. [Full Text] [PDF]

				R. J. Adams, M. I. Chimowitz, J. S. Alpert, I. A. Awad, M. D. Cerqueria, P. Fayad, and K. A. Taubert Coronary Risk Evaluation in Patients With Transient Ischemic Attack and Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/American Stroke Association Stroke, September 1, 2003; 34(9): 2310 - 2322. [Full Text] [PDF]