Family Med Medical News about Ischemic stroke;atrial fibrillation

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Echocardiographic and clinical risk factors for atrial fibrillation in hypertensive patients with ischemic stroke
The American Journal of Cardiology, 11/17/08

Haft JI et al. – Hypertensive pts with echocardiographic and clinical risk factors should undergo prolonged electrocardiographic event monitoring to identify occult intermittent atrial fibrillation (AF) to aid prevention of a second stroke and possibly a first stroke.

Methods

Retrospective study of 799 pts admitted with ischemic stroke over 31 mo to determine the importance of AF in nonhemorrhagic stroke

Results

AF present on admitting electrocardiogram in 154 pts (19.3%), diagnosed later during stroke admission in 58 (7.3%), and found only during another admission before/after the stroke admission in 46 (5.8%)
AF intermittent in 123 pts, 47.7% of AF pts, and not present on initial electrocardiogram in 40.3% of pts with AF
In 633 hypertensive pts, AF occurred in 34.9% vs 22.2% without hypertension
In pts with AF vs without AF, echocardiogram showed a left atrium ≥4 cm in 81.3% vs 42.4%; ejection fraction<50% in 27.7% vs 12.6%; left ventricle ≥5.6 cm in 13.8% vs 6.7%
Clinically, congestive heart failure (31% vs 10.4%) and coronary disease (31% vs 21.4%) more often present in AF pts
Left ventricular hypertrophy, diastolic dysfunction, and diabetes common in all hypertensive pts with stroke

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