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Non Rheumatic Atrial Fibrillation as Risk of Stroke

Received: 21 October 2016     Accepted: 1 November 2016     Published: 25 November 2016
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Abstract

Atrial fibrillation (AF) is one of the main risk factor for ischemic stroke. The reason for an increased stroke risk in AF has always been claimed to be the occurrence of left atrial thrombosis causing arterial embolism. In patients with Rheumatic heart disease especially mitral valve stenosis with AF, the frequency of atrial thrombosis has found to be 30 - 42% (Keren G et al. 1987), and the prevalence of left atrial thrombosis in NRAF are higher than in control 13-27% (Petersen P et al. 1988). Objectives: We investigated if there are any differences in risk factors or atherosclerotic manifestations between ischemic brain infarction patients with and without AF? Are the brain lesions characteristics in these patients similar?Patients and Methods: This is a case- control study of 26 patients with acute ischemic stroke and NRAF (case subjects) a and 26 patients with acute ischemic stroke and sinus rhythm. (control subjects). The patients admitted to the hospital; the diagnosis of cerebral infarction was confirmed by new CT of the brain. All the participants underwent the standard examination and testing as well as ECG and ECHO. Result: Patient with NRAF had higher mortality 30% than in control (SR) 7% (P<0.001). NRAF patients had positive brain CT finding 68% compared to 23% of the SR Patients (P<0.001). Conclusion: Brain infarction in non-Rheumatic AF group are more serious than other and therefor make up a (high risk) group for which acute treatment would be specially indicated and primary prophylaxis with anticoagulants might therefore be considered.

Published in American Journal of Internal Medicine (Volume 4, Issue 6)
DOI 10.11648/j.ajim.20160406.15
Page(s) 117-119
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2016. Published by Science Publishing Group

Keywords

Cerebral Vascular Accident (CVA), Non Rheumatic Atrial Fibrillation (NRAF), Sinus Rhythm (SR), Electrocardiography (ECG), Echocardiography (ECHO), Atrial Fibrillation (AF)

References
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[2] Cai H, Li Z, Goette A, Mera F, Honeycutt C, Feterik K, et al. Down regulation of endocardial nitric oxide synthase expression and nitric oxide production in atrial fibrillation: potential mechanisms for atrial thrombosis and stroke. Circulation. 2002: 106: 2854-2858.
[3] Easton JD, Sherman DG: Management of cerebral embolism of cardiac origin. Stroke11: 433-442, 1980.
[4] Frustaci A, Chimenti C, Bellocci F. Morgante E, Russo MA, Maseri A. Histological substrate of atrial biopsies in patients with lone atrial fibrillation. Circulation. 1997; 96: 1180-1184.
[5] Heijman J, Voiget N, Nattel S, Dobrev D. Cellular and molecular electrophysiology of atrial fibrillation initiation maintenance and progression Circ Res. 2014; 114: 1483-1499. Doi: 10.1161/ CIRCRESAHA.114.302226.
[6] Kannel WB, Abbott RD, Savage DD, McNamara PM, Epidemiologic features of chronic atrial fibrillation: the Framingham study N Engl J. Med. 1982; 306: 1018-1022.
[7] Kannel WB, Wolf PA, Verter J: manifestations of coronary disease predisposing to stroke: The Framingham Study. JAMA 1983; 250: 2942-2946.
[8] Keren G, Etzion T, Sherez J, Zelcer A, Megidish R, Miller H, Laniado S. Atrial fibrillation and atrial enlargement in patients with mitral stenosis. Am Heart J. 1987; 114: 1146-1155.
[9] Lodder J, Bamford JM, Sandercock PA, Jones LN, Warlow CP. Are hypertension or cardiac embolism likely causes of lacunar infarction? Stroke. 1990; 21: 375-381.
[10] Mihm MJ, Yu F, Carnes CA, Reiser PJ, McCarthy, PM, Van Wagoner DR, et al. Impaired myofrillar energetics and oxidative injury during human atrial fibrillation. Circulation. 2001; 104: 174-180.
[11] Peterson P, Godtfredsen J: Risk factor for stroke in chronic atrial fibrillation. Eur Heart J 1988; 9: 291-294.
[12] Roden A, Britton M: Progression of stroke after arrival at hospital. Acta Neurol Scand 66 (suppl 91): 43, 1982.
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[14] Jorgensen L, Torvic A: Ischemic cerebrovascular diseases in an autopsy series. Part 2. Prevalence, location, pathogenesis, and clinical course of cerebral infarcts. J Neurol Sci 9: 285-320, 1969.
[15] Warraich HJ, Gandhavadi M, Manning WJ. Mechanical discordance of the left atrium and appendage: a novel mechanism of stroke in paroxysmal atrial fibrillation, Stroke. 2014; 45: 1481-1484, doi: 10.1161/STROKEAHA.114.004800.
[16] Weyman AE. Principles and practice of echocardiography, Lea and Febiger Publ. 194; 606.
[17] Wolf PA, Abbott RD, Kannel WB: Atrial fibrillation: A major contributor to stroke in the elderly. Am Heart J 1986; 112: 1039-1043.
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Cite This Article
  • APA Style

    Ali Areef Fadhlullah, Asgad A. Abdalgbar, Hanan K. Altalhi. (2016). Non Rheumatic Atrial Fibrillation as Risk of Stroke. American Journal of Internal Medicine, 4(6), 117-119. https://doi.org/10.11648/j.ajim.20160406.15

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    ACS Style

    Ali Areef Fadhlullah; Asgad A. Abdalgbar; Hanan K. Altalhi. Non Rheumatic Atrial Fibrillation as Risk of Stroke. Am. J. Intern. Med. 2016, 4(6), 117-119. doi: 10.11648/j.ajim.20160406.15

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    AMA Style

    Ali Areef Fadhlullah, Asgad A. Abdalgbar, Hanan K. Altalhi. Non Rheumatic Atrial Fibrillation as Risk of Stroke. Am J Intern Med. 2016;4(6):117-119. doi: 10.11648/j.ajim.20160406.15

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  • @article{10.11648/j.ajim.20160406.15,
      author = {Ali Areef Fadhlullah and Asgad A. Abdalgbar and Hanan K. Altalhi},
      title = {Non Rheumatic Atrial Fibrillation as Risk of Stroke},
      journal = {American Journal of Internal Medicine},
      volume = {4},
      number = {6},
      pages = {117-119},
      doi = {10.11648/j.ajim.20160406.15},
      url = {https://doi.org/10.11648/j.ajim.20160406.15},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20160406.15},
      abstract = {Atrial fibrillation (AF) is one of the main risk factor for ischemic stroke. The reason for an increased stroke risk in AF has always been claimed to be the occurrence of left atrial thrombosis causing arterial embolism. In patients with Rheumatic heart disease especially mitral valve stenosis with AF, the frequency of atrial thrombosis has found to be 30 - 42% (Keren G et al. 1987), and the prevalence of left atrial thrombosis in NRAF are higher than in control 13-27% (Petersen P et al. 1988). Objectives: We investigated if there are any differences in risk factors or atherosclerotic manifestations between ischemic brain infarction patients with and without AF? Are the brain lesions characteristics in these patients similar?Patients and Methods: This is a case- control study of 26 patients with acute ischemic stroke and NRAF (case subjects) a and 26 patients with acute ischemic stroke and sinus rhythm. (control subjects). The patients admitted to the hospital; the diagnosis of cerebral infarction was confirmed by new CT of the brain. All the participants underwent the standard examination and testing as well as ECG and ECHO. Result: Patient with NRAF had higher mortality 30% than in control (SR) 7% (P<0.001). NRAF patients had positive brain CT finding 68% compared to 23% of the SR Patients (P<0.001). Conclusion: Brain infarction in non-Rheumatic AF group are more serious than other and therefor make up a (high risk) group for which acute treatment would be specially indicated and primary prophylaxis with anticoagulants might therefore be considered.},
     year = {2016}
    }
    

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  • TY  - JOUR
    T1  - Non Rheumatic Atrial Fibrillation as Risk of Stroke
    AU  - Ali Areef Fadhlullah
    AU  - Asgad A. Abdalgbar
    AU  - Hanan K. Altalhi
    Y1  - 2016/11/25
    PY  - 2016
    N1  - https://doi.org/10.11648/j.ajim.20160406.15
    DO  - 10.11648/j.ajim.20160406.15
    T2  - American Journal of Internal Medicine
    JF  - American Journal of Internal Medicine
    JO  - American Journal of Internal Medicine
    SP  - 117
    EP  - 119
    PB  - Science Publishing Group
    SN  - 2330-4324
    UR  - https://doi.org/10.11648/j.ajim.20160406.15
    AB  - Atrial fibrillation (AF) is one of the main risk factor for ischemic stroke. The reason for an increased stroke risk in AF has always been claimed to be the occurrence of left atrial thrombosis causing arterial embolism. In patients with Rheumatic heart disease especially mitral valve stenosis with AF, the frequency of atrial thrombosis has found to be 30 - 42% (Keren G et al. 1987), and the prevalence of left atrial thrombosis in NRAF are higher than in control 13-27% (Petersen P et al. 1988). Objectives: We investigated if there are any differences in risk factors or atherosclerotic manifestations between ischemic brain infarction patients with and without AF? Are the brain lesions characteristics in these patients similar?Patients and Methods: This is a case- control study of 26 patients with acute ischemic stroke and NRAF (case subjects) a and 26 patients with acute ischemic stroke and sinus rhythm. (control subjects). The patients admitted to the hospital; the diagnosis of cerebral infarction was confirmed by new CT of the brain. All the participants underwent the standard examination and testing as well as ECG and ECHO. Result: Patient with NRAF had higher mortality 30% than in control (SR) 7% (P<0.001). NRAF patients had positive brain CT finding 68% compared to 23% of the SR Patients (P<0.001). Conclusion: Brain infarction in non-Rheumatic AF group are more serious than other and therefor make up a (high risk) group for which acute treatment would be specially indicated and primary prophylaxis with anticoagulants might therefore be considered.
    VL  - 4
    IS  - 6
    ER  - 

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Author Information
  • Faculty of Medicine, University of Omar El mukhtar, Albayda, Libya

  • Faculty of Medicine, University of Omar El mukhtar, Albayda, Libya

  • Faculty of Medicine, University of Omar El mukhtar, Albayda, Libya

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