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Bai X, Wang N, Si Y, Liu Y, Yin P, Xu C. The Clinical Characteristics of Heart Rate Variability After Stroke: A Systematic Review. Neurologist 2024; 29:133-141. [PMID: 38042172 DOI: 10.1097/nrl.0000000000000540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
The autonomic nervous system dysfunction has been reported in up to 76% of stroke patients 7 days after an acute stroke. Heart rate variability (HRV) is one of the important indicators reflecting the balance of sympathetic and parasympathetic nerves. Therefore, we performed a systematic literature review of existing literature on the association between heart rate variability and the different types of stroke. We included studies published in the last 32 years (1990 to 2022). The electronic databases MEDLINE and PubMed were searched. We selected the research that met the inclusion or exclusion criteria. A narrative synthesis was performed. This review aimed to summarize evidence regarding the potential mechanism of heart rate variability among patients after stroke. In addition, the association of clinical characteristics of heart rate variability and stroke has been depicted. The review further discussed the relationship between post-stroke infection and heart rate variability, which could assist in curbing clinical infection in patients with stroke. HRVas a noninvasive clinical monitoring tool can quantitatively assess the changes in autonomic nervous system activity and further predict the outcome of stroke. HRV could play an important role in guiding the clinical practice for autonomic nervous system disorder after stroke.
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Affiliation(s)
- Xue Bai
- Department of Cardiov ascular Surgery
| | - Na Wang
- Department of Cardiology, Daping Hospital, The Third Military Medical University
- Chongqing Institute of Cardiology & Chongqing Key Laboratory of Hypertension Research, Chongqing, China
| | - Yueqiao Si
- Department of Cardiology, Daping Hospital, The Third Military Medical University
- Chongqing Institute of Cardiology & Chongqing Key Laboratory of Hypertension Research, Chongqing, China
| | - Yunchang Liu
- Department of Cardiology, Daping Hospital, The Third Military Medical University
- Chongqing Institute of Cardiology & Chongqing Key Laboratory of Hypertension Research, Chongqing, China
| | - Ping Yin
- Department of Cardiology, Daping Hospital, The Third Military Medical University
- Chongqing Institute of Cardiology & Chongqing Key Laboratory of Hypertension Research, Chongqing, China
| | - Chunmei Xu
- Department of Cardiology, Daping Hospital, The Third Military Medical University
- Chongqing Institute of Cardiology & Chongqing Key Laboratory of Hypertension Research, Chongqing, China
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Roman-Filip I, Morosanu V, Bajko Z, Roman-Filip C, Balasa RI. Non-Aneurysmal Perimesencephalic Subarachnoid Hemorrhage: A Literature Review. Diagnostics (Basel) 2023; 13:diagnostics13061195. [PMID: 36980503 PMCID: PMC10047780 DOI: 10.3390/diagnostics13061195] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Spontaneous non-aneurysmal subarachnoid haemorrhage (NAPMSAH) (addressing point 1) is a relatively rare occurrence in clinical settings as it is rarely misdiagnosed and usually involves a significantly better prognosis than the classical aneurysmal pattern. We hereby focused on a comprehensive analysis of this distinct pathological entity with the purpose of analysing possible pathophysiological entities, outcomes and treatment options involving this diagnosis with a focus on demographical, epidemiological and clinical data. The clinical setting includes focal neurological signs related to the anatomical structures, while computer tomography followed by tomographic angiography are the most common diagnosis tools, with a typical hyperdense lesion involving the midbrain, fourth ventricle and subthalamic areas without an angiographic correspondent, such as an aneurysmal pathology. Further investigations can also be used to highlight this diagnosis, such as interventional angiography or magnetic resonance imaging. Given the rarity of this condition and its relatively better prognosis, treatment options usually remain conservative. In the present review, the main characteristics of NAPMSAH are discussed.
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Affiliation(s)
- Iulian Roman-Filip
- Department of Neurology, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania
| | - Valentin Morosanu
- Department of Neurology, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania
| | - Zoltan Bajko
- Department of Neurology, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania
| | - Corina Roman-Filip
- Department of Neurology, "Lucian Blaga" University of Sibiu Faculty of Medicine, 550169 Sibiu, Romania
| | - Rodica Ioana Balasa
- Department of Neurology, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania
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Sposato LA, Hilz MJ, Aspberg S, Murthy SB, Bahit MC, Hsieh CY, Sheppard MN, Scheitz JF. Post-Stroke Cardiovascular Complications and Neurogenic Cardiac Injury: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 76:2768-2785. [PMID: 33272372 DOI: 10.1016/j.jacc.2020.10.009] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023]
Abstract
Over 1.5 million deaths worldwide are caused by neurocardiogenic syndromes. Furthermore, the consequences of deleterious brain-heart interactions are not limited to fatal complications. Cardiac arrhythmias, heart failure, and nonfatal coronary syndromes are also common. The brain-heart axis is implicated in post-stroke cardiovascular complications known as the stroke-heart syndrome, sudden cardiac death, and Takotsubo syndrome, among other neurocardiogenic syndromes. Multiple pathophysiological mechanisms with the potential to be targeted with novel therapies have been identified in the last decade. In the present state-of-the-art review, we describe recent advances in the understanding of anatomical and functional aspects of the brain-heart axis, cardiovascular complications after stroke, and a comprehensive pathophysiological model of stroke-induced cardiac injury.
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Affiliation(s)
- Luciano A Sposato
- Heart & Brain Laboratory, Western University, London, Ontario, Canada; Departments of Clinical Neurological Sciences, Epidemiology and Biostatistics, and Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada; Robarts Research Institute, London, Ontario, Canada.
| | - Max J Hilz
- University of Erlangen-Nuremberg, Erlangen, Germany; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sara Aspberg
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Santosh B Murthy
- Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York. https://twitter.com/san_murthy
| | - M Cecilia Bahit
- INECO Neurociencias Oroño, Rosario, Santa Fe, Argentina. https://twitter.com/ceciliabahit
| | - Cheng-Yang Hsieh
- Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan; School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan. https://twitter.com/chengyanghsieh
| | - Mary N Sheppard
- Molecular and Clinical Sciences Research Institute, St George's, University of London, London, United Kingdom
| | - Jan F Scheitz
- Klinik für Neurologie mit Experimenteller Neurologie and Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislaufforschung), partner site Berlin, Charité-Universitätsmedizin Berlin, Germany; Berlin Institute of Health, Berlin, Germany. https://twitter.com/Jan_FriSch
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Zhang L, Qi S. Electrocardiographic Abnormalities Predict Adverse Clinical Outcomes in Patients with Subarachnoid Hemorrhage. J Stroke Cerebrovasc Dis 2016; 25:2653-2659. [PMID: 27476337 DOI: 10.1016/j.jstrokecerebrovasdis.2016.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/13/2016] [Accepted: 07/02/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We conducted a retrospective cohort study of a large sample to assess whether electrocardiographic (ECG) abnormalities are independently associated with the occurrence of neurogenic pulmonary edema (NPE), delayed cerebral ischemia (DCI), and in-hospital death after nontraumatic subarachnoid hemorrhage (SAH). METHODS In this retrospective observational study, patients who were admitted within 72 hours of SAH symptom onset between 2013 and 2015 were enrolled. Twelve-lead ECG findings obtained within 72 hours after SAH and the presence of NPE, DCI, and in-hospital death were collected based on the results reported in the medical records. RESULTS We included 834 patients. NPE occurred in 192 patients (23%). The median delay from SAH onset to NPE was 3 days (interquartile range [IQR]: 5 days). DCI occurred in 223 patients (27%; median delay to DCI, 4 days; IQR: 5 days). In total, 141 patients (17%) died in the hospital (median time to death, 12 days; IQR: 18 days). The frequency of ECG abnormalities for all enrolled patients was 65%. Corrected QT prolongation had an adjusted risk ratio (RR) of 1.5 (1.1-2.2) for NPE and 1.8 (1.3-2.4) for DCI. ST depression had an adjusted RR of 3.0 (1.2-7.5) for in-hospital death. NSSTTCs (nonspecific ST- or T-wave changes) had an adjusted RR of 2.7 (1.8-4.2) for NPE, 2.8 (1.9-4.3) for DCI, and 2.2 (1.3-3.5) for in-hospital death. All RRs were adjusted for age and Hunt-Hess scores. CONCLUSIONS ECG abnormalities assessed within 72 hours after SAH using a standard 12-lead ECG are independently associated with an increased risk of adverse clinical outcomes in patients with nontraumatic SAH.
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Affiliation(s)
- Limin Zhang
- Department of Anaesthesiology, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Sihua Qi
- Department of Anaesthesiology, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, China.
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Oppenheimer S, Cechetto D. The Insular Cortex and the Regulation of Cardiac Function. Compr Physiol 2016; 6:1081-133. [DOI: 10.1002/cphy.c140076] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Takahashi C, Hinson HE, Baguley IJ. Autonomic dysfunction syndromes after acute brain injury. HANDBOOK OF CLINICAL NEUROLOGY 2015; 128:539-51. [PMID: 25701906 DOI: 10.1016/b978-0-444-63521-1.00034-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The central autonomic nervous system (CAN) is a multifaceted, richly connected neural network incorporating the hypothalamus, its descending tracts through the brainstem, the insular cortex and down into the spinal cord. All levels of the CAN are susceptible to injury following traumatic brain injury (TBI), whether from focal or diffuse injury. Focal injuries would be expected to produce localized damage to CAN control centers, whereas the effects of diffuse injuries are presumed to be more diverse and/or widely distributed. As the combination of focal and diffuse injury following TBI can vary widely from one individual to the next, the impact of focal injuries is best understood with reference to the focal ischemic stroke literature. Subarachnoid hemorrhage (SAH), a common complication following TBI, also has predictable effects on autonomic control that can be understood with reference to spontaneous SAH literature. Finally, paroxysmal sympathetic hyperactivity (PSH), a syndrome incorporating episodes of heightened sympathetic drive and motor overactivity following minor stimulation, is discussed as an example of what happens when central inhibitory control of spinal cord autonomics is impaired.
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Affiliation(s)
- Courtney Takahashi
- Department of Neurology and Neurocritical Care, Oregon Health and Science University, Portland, OR, USA
| | - Holly E Hinson
- Department of Neurology and Neurocritical Care, Oregon Health and Science University, Portland, OR, USA
| | - Ian J Baguley
- Brain Injury Rehabilitation Service, Westmead Hospital, Sydney, Australia.
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Capparelli FJ, Abello M, Patricio Maskin L, Arista E, Hlavnicka A, Diaz MF, Varela D, Wainsztein NA. QTc prolongation after brain surgery. Neurol Res 2013; 35:159-62. [DOI: 10.1179/1743132813y.0000000169] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Federico J Capparelli
- Intensive Care UnitInternal Medicine Department, Raul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
| | - Mauricio Abello
- Cardiology DepartmentRaul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
| | - L Patricio Maskin
- Intensive Care UnitInternal Medicine Department, Raul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
| | - Eugenia Arista
- Intensive Care UnitInternal Medicine Department, Raul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
| | - Alejandro Hlavnicka
- Intensive Care UnitInternal Medicine Department, Raul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
| | - Maria Fernanda Diaz
- Intensive Care UnitInternal Medicine Department, Raul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
| | - Daniel Varela
- Intensive Care UnitInternal Medicine Department, Raul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
| | - Nestor A Wainsztein
- Intensive Care UnitInternal Medicine Department, Raul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
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9
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Electrocardiographic abnormalities and cardiac arrhythmias in structural brain lesions. Int J Cardiol 2013; 167:328-34. [DOI: 10.1016/j.ijcard.2012.06.107] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 05/02/2012] [Accepted: 06/24/2012] [Indexed: 11/21/2022]
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Togha M, Sharifpour A, Ashraf H, Moghadam M, Sahraian MA. Electrocardiographic abnormalities in acute cerebrovascular events in patients with/without cardiovascular disease. Ann Indian Acad Neurol 2013; 16:66-71. [PMID: 23661966 PMCID: PMC3644785 DOI: 10.4103/0972-2327.107710] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 11/13/2011] [Accepted: 06/22/2012] [Indexed: 01/29/2023] Open
Abstract
Objectives: Electrocardiographic (ECG) changes are reported frequently after acute strokes. It seems that cardiovascular effects of strokes are modulated by concomitant or pre-existent cardiac diseases, and are also related to the type of cerebrovascular disease and its localization. We aimed to determine the pattern of ECG changes associated with pathophysiologic categories of acute stroke among patients with/without cardiovascular disease and to determine if specific ECG changes are related to the location of the lesion. Materials and Methods The electrocardiographic records of 361 patients with acute stroke were studied to assess the relative frequencies of ECG abnormalities among the pathophysiologic categories of stroke. Results: In the present study, the most common ECG abnormalities associated with stroke were T-wave abnormalities, prolonged QTc interval and arrhythmias, which were respectively found in 39.9%, 32.4%, and 27.1% of the stroke patients and 28.9%, 30.7%, and 16.2 of the patients with no primary cardiac disease. We observed that other ECG changes comprising pathologic Q- wave, ST-segment depression, ST-segment elevation, and prominent U wave may also occur in selected or non-selected stroke patients; thereby simulate an acute myocardial injury. We observed an increased number of patients with abnormal T-wave and posterior fossa bleedings and more rhythm disturbances for ischemic lesions, localized in the anterior fossa. Conclusion: Ischemia-like ECG changes and arrhythmias are frequently seen in stroke patients, even in those with no history or signs of primary heart disease, which support a central nervous system origin of these ECG abnormalities. Further study is necessary to better define the brain-heart interaction.
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Junttila E, Vaara M, Koskenkari J, Ohtonen P, Karttunen A, Raatikainen P, Ala-Kokko T. Repolarization Abnormalities in Patients with Subarachnoid and Intracerebral Hemorrhage. Anesth Analg 2013; 116:190-7. [DOI: 10.1213/ane.0b013e318270034a] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Nomura Y, Kawaguchi M, Yoshitani K, Kurita N, Hayashi H, Tamura K, Motoyama Y, Nakase H, Furuya H. Retrospective analysis of predictors of cerebral vasospasm after ruptured cerebral aneurysm surgery: influence of the location of subarachnoid blood. J Anesth 2009; 24:1-6. [PMID: 20039076 DOI: 10.1007/s00540-009-0836-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 08/23/2009] [Indexed: 11/27/2022]
Abstract
PURPOSE The amount of blood on computed tomography (CT) has been shown to be a predictor of cerebral vasospasm after subarachnoid hemorrhage (SAH). However, the influence of the location of the blood on the incidence of vasospasm remains unclear. We retrospectively assessed the association of the blood volumes in the individual components (cisterns and fissures) of CT scans with angiographic vasospasm after SAH. METHODS One hundred forty-nine SAH patients scheduled for cerebral aneurysm clipping were enrolled. The amount of subarachnoid blood was classified using the Fisher CT grade. The amounts of subarachnoid blood in 5 cisterns or 3 fissures were also evaluated using SAH scores ranging from 0 to 3 (0, no blood; 3, completely filled with blood). Cerebral vasospasm was diagnosed by the results of angiography. RESULTS Angiographic vasospasm developed in 51 of 149 patients (34%). Of those, 26 patients were symptomatic. The Fisher CT grade and SAH scores in the right and left sylvian fissures and suprasellar cisterns were significantly higher in patients with angiographic vasospasm than in those without it. Univariate logistic regression analysis revealed that a high Fisher CT grade and high SAH scores in the right and left sylvian fissures and suprasellar cisterns were predictors of angiographic vasospasm. Multivariate analysis indicated that the SAH score in the right sylvian fissure was an independent predictor of angiographic vasospasm (odds ratio, 3.6; 95% confidence interval (CI), 1.7-7.7; P = 0.01). CONCLUSION The results indicated that the amount of blood in the right sylvian fissure was significantly associated with the development of angiographic vasospasm after SAH.
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Affiliation(s)
- Yasumitsu Nomura
- Department of Anesthesiology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
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Ozdemir O, Hachinski V. Brain lateralization and sudden death: Its role in the neurogenic heart syndrome. J Neurol Sci 2008; 268:6-11. [DOI: 10.1016/j.jns.2007.11.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2007] [Accepted: 11/15/2007] [Indexed: 10/22/2022]
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Jespersen CM, Fischer Hansen J. Myocardial stress in patients with acute cerebrovascular events. Cardiology 2007; 110:123-8. [PMID: 17975312 DOI: 10.1159/000110491] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Accepted: 04/17/2007] [Indexed: 01/28/2023]
Abstract
Signs of myocardial involvement are common in patients with acute cerebrovascular events. ST segment deviations, abnormal left ventricular function, increased N-terminal pro-brain natriuretic peptide (NT-proBNP), prolonged QT interval, and/or raised troponins are observed in up to one third of the patients. The huge majority of these findings are fully reversible. The changes may mimic myocardial infarction, but are not necessarily identical to coronary thrombosis. Based on the literature these signs may represent an acute catecholamine release provoked by the cerebrovascular catastrophe itself and not coronary thrombosis. However, all patients with signs of cardiac involvement during acute cerebrovascular events should receive a cardiological follow-up in order to exclude concomitant ischemic heart disease.
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Abstract
Aneurysmal subarachnoid hemorrhage (SAH) is analogous to a pathophysiological watershed, disrupting brain integrity and function and precipitating an array of systemic derangements including cardiovascular, respiratory, endocrine, hematological, and immune dysfunction. Extracerebral organ dysfunction is closely linked to the magnitude of the primary neurological insult, suggesting neurogenic, neuroendocrine and neuroimmunomodulatory mechanisms. Systemic organ involvement is associated with increased mortality and neurological impairment, even after adjustment for other outcome predictors such as the severity of the initial neurological injury. This may be a reflection of secondary brain injury precipitated by hypoxemia, circulatory failure, fever, or hyperglycemia, all of which have been linked to adverse clinical outcomes. Interventions to avert or reverse these and other perturbations need to be tested in clinical trials as they represent opportunities to improve survival and neurological recovery in patients with SAH.
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Affiliation(s)
- Robert D Stevens
- Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Qureshi AI, Ezzeddine MA, Nasar A, Suri MFK, Kirmani JF, Hussein HM, Divani AA, Reddi AS. Prevalence of elevated blood pressure in 563,704 adult patients with stroke presenting to the ED in the United States. Am J Emerg Med 2007; 25:32-8. [PMID: 17157679 PMCID: PMC2443694 DOI: 10.1016/j.ajem.2006.07.008] [Citation(s) in RCA: 299] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Revised: 07/05/2006] [Accepted: 07/10/2006] [Indexed: 01/15/2023] Open
Abstract
PURPOSE The aim of this study was to estimate the prevalence of elevated blood pressure in adult patients with acute stroke in the United States (US). METHODS Patients with stroke were classified by initial systolic blood pressure (SBP) into 4 categories using demographic, clinical, and treatment data from the National Hospital Ambulatory Medical Care Survey, the largest study of use and provision of emergency department (ED) services in the United States. We also compared the age-, sex-, and ethnicity-adjusted rates of elevated blood pressure strata, comparable with stages 1 and 2 hypertension in the US population. RESULTS Of the 563704 patients with stroke evaluated, initial SBP was below 140 mm Hg in 173120 patients (31%), 140 to 184 mm Hg in 315207 (56%), 185 to 219 mm Hg in 74586 (13%), and 220 mm Hg or higher in 791 (0.1%). The mean time interval between presentation and evaluation was 40 +/- 55, 33 +/- 39, 25 +/- 27, and 5 +/- 1 minutes for increasing SBP strata (P = .009). A 3- and 8-fold higher rate of elevated blood pressure strata was observed in acute stroke than the existing rates of stages 1 and 2 hypertension in the US population. Labetalol and hydralazine were used in 6126 (1%) and 2262 (0.4%) patients, respectively. Thrombolytics were used in 1283 patients (0.4%), but only in those with SBP of 140 to 184 mm Hg. CONCLUSIONS In a nationally representative large data set, elevated blood pressure was observed in over 60% of the patients presenting with stroke to the ED. Elevated blood pressure was associated with an earlier evaluation; however, the use of thrombolytics was restricted to patients with ischemic stroke with SBP below 185 mm Hg.
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Affiliation(s)
- Adnan I Qureshi
- Epidemiological and Outcomes Research Division, Zeenat Qureshi Stroke Research Center, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ 07103, USA.
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Qureshi AI, Mohammad YM, Yahia AM, Suarez JI, Siddiqui AM, Kirmani JF, Suri MFK, Kolb J, Zaidat OO. A prospective multicenter study to evaluate the feasibility and safety of aggressive antihypertensive treatment in patients with acute intracerebral hemorrhage. J Intensive Care Med 2005; 20:34-42. [PMID: 15665258 DOI: 10.1177/0885066604271619] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors performed a multicenter prospective observational study to evaluate the feasibility and safety of intravenous antihypertensive protocol for acute hypertension in patients with intracerebral hemorrhage (ICH). Twenty-seven patients with ICH and acute hypertension (mean age 61.37 +/- 14.27; 10 were men) were treated to maintain the systolic blood pressure (BP) below 160 mm Hg and diastolic BP below 90 mm Hg within 24 hours of symptom onset. Neurological deterioration (defined as a decrease in initial Glasgow Coma Scale score > or = 2) was observed in 2 (7.4%) of 27 patients during treatment. Among patients who underwent follow-up computed tomography, hematoma expansion (more than 33% increase in hematoma size at 24 hours) was observed in 2 (9.1%) of 22 patients. Patients treated within 6 hours of symptom onset were more likely to be functionally independent (modified Rankin scale < or = 2) at 1 month compared with patients who were treated between 6 and 24 hours (8 of 18 versus 0 of 9,P = .03). Aggressive pharmacological treatment of acute hypertension in patients with ICH can be initiated early with a low rate of neurological deterioration and hematoma expansion.
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Affiliation(s)
- Adnan I Qureshi
- Zennat Qureshi Stroke Research Center, Department of Neurology and Neurosciences, University of Medicine and Dentistry of New Jersey, Newark, NJ 07103-2425, USA.
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Shinoura N, Yamada R. Head-down manoeuvre in patients with a high symptom score for orthostatic intolerance reveals impaired right brain frontal lobe vasoreactivity. Clin Neurophysiol 2005; 116:1286-90. [PMID: 15978491 DOI: 10.1016/j.clinph.2005.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2004] [Revised: 01/14/2005] [Accepted: 02/09/2005] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Autonomic nerve dysregulation produces a sense of impaired well-being and interferes with work performance in affected individuals. In this study, we characterized the pathophysiology of this condition. METHODS Six patients with high symptom scores for orthostatic intolerance (OI) along with age- and sex-matched normal volunteers were directed to perform a head-down manoeuvre, and the change in cerebral blood flow (CBF) and cerebral oxygen levels (rSO(2)) in the right and left frontal lobes was measured using near-infrared spectroscopy (NIRS). RESULTS The head-down manoeuvre induced a much greater increase in right-sided total haemoglobin concentration (THbl) in normal volunteers (0.51+/-0.24) when compared to symptomatic patients (0.0+/-0.04) but had no effect on left-sided THbl (P<0.05) in either group. Five of 6 patients showed a gradual decrease in right-sided THbl when assuming a sitting position, and all patients with this pattern complained of symptoms of multiple autonomic dysfunction. Further, this pattern of changes in right-sided THbl was not observed in normal volunteers. CONCLUSIONS The gradual decrease of THbl with the sitting position and the lack of increase during the head-down manoeuvre in symptomatic patients suggest that these patients have impaired vasoreactivity in the right frontal lobes. SIGNIFICANCE This impaired vasoreactivity likely reflects dysfunction of the right hemisphere and the sympathetic nervous system in patients with OI.
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Affiliation(s)
- Nobusada Shinoura
- Department of Neurosurgery, Komagome Metropolitan Hospital, 3-18-22 Hon-Komagome, Bunkyo-ku, Tokyo 113-8677, Japan.
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Macrea LM, Tramèr MR, Walder B. Spontaneous subarachnoid hemorrhage and serious cardiopulmonary dysfunction--a systematic review. Resuscitation 2005; 65:139-48. [PMID: 15866393 DOI: 10.1016/j.resuscitation.2004.11.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2004] [Revised: 10/22/2004] [Accepted: 11/05/2004] [Indexed: 11/18/2022]
Abstract
INTRODUCTION : The association between the degree of neurological deficit and cardiopulmonary dysfunction in patients with spontaneous subarachnoid hemorrhage (SAH) is poorly understood. METHOD A systematic search (MEDLINE, bibliographies, to 9.2004) was performed for prospective studies (any architecture; > or = 10 patients with SAH), reporting on neurological deficit and cardiopulmonary dysfunction. Neurological deficit was graded according to the Hunt-Hess or Botterell scores as minimal (1 or 2 points), moderate (3), or severe (4 or 5), and tested for an association with cardiopulmonary dysfunction (Chi-square test). RESULTS Relevant data came from two randomized trials, four case control studies, and 31 uncontrolled series. In eight studies (386 patients), ECG abnormalities were found in 32% of patients with minimal, 55% with moderate, and 58% with severe neurological deficit (P < 0.0001). In six studies (135), echocardiographic abnormalities were found in 4% of patients with minimal, 30% with moderate, and 52% with severe neurological deficit (P = 0.0001). In two trials (63), creatinine phosphoskinase was increased in 18% of patients with minimal, 71% with moderate, and 100% with severe neurological deficit (P < 0.0001). In three trials (309), troponin-I was increased in 10% of patients with minimal, 20% of patients with moderate, and 46% with severe neurological deficit (P < 0.0001). In five trials (163), pulmonary edema was found in 4% of patients with minimal, 12% with moderate, and 35% with severe neurological deficit (P < 0.0001). Seventeen studies reported on mortality; 26% of the patients died, 80% of deaths were directly related to SAH. CONCLUSIONS In patients with spontaneous SAH, cardiopulmonary dysfunction is more likely to occur with increasing neurological deficit.
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Affiliation(s)
- Lucian M Macrea
- Division of Anesthesiology, Department APSIC (Anesthesiology, Pharmacology, and Surgical Intensive Care), Geneva University Hospitals, Rue Micheli Du Crest 24, CH-1211, Geneva 14, Switzerland.
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Sivakumar R. Atypical site of myocardial infarction pain. Am J Emerg Med 2002; 20:388. [PMID: 12098205 DOI: 10.1053/ajem.2002.33961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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