Specific cardiac disorders in 402 consecutive patients with ischaemic cardioembolic stroke.

BACKGROUND: To determine the cardiological substrate in acute stroke patients presenting with a cardioembolic stroke subtype. METHODS: Data of 402 consecutive patients with cardioembolic stroke (cerebral infarction, n=347; transient ischaemic attack, n=55) were collected from a prospective hospital-based stroke registry in which data on 2000 stroke patients over a 10-year period were included. In all patients, specific cardiac disorders were identified by physical examination and results of electrocardiography and transthoracic echocardiography. Holter monitoring and more sensitive techniques of cardiac imaging were used in selected cases. RESULTS: Cardioembolic cerebral ischaemia accounted for 20% of all acute strokes (25% of ischaemic cerebrovascular events). Cardiac sources of embolism included the following: (a) structural cardiac disorders associated with arrhythmia (n=232), the most frequent being left ventricular hypertrophic hypertensive disease (n=120) and rheumatic mitral valve disease (n=49); (b) structural cardiac disease with sustained sinus rhythm (n=81), the most frequent being systolic left ventricular dysfunction of both ischaemic (n=35) or non-ischaemic (n=24) aetiology; and (c) isolated atrial dysrhythmia (atrial fibrillation, n=88 and atrial flutter, n=1). CONCLUSIONS: Hypertrophic hypertensive cardiac disease complicated with atrial fibrillation was the most frequent cardiac source of emboli in cardioembolic stroke. Other important cardiac sources were isolated atrial fibrillation, rheumatic mitral valve disease, and systolic left ventricular dysfunction of ischaemic and non-ischaemic cause. The incidence of traditional emboligenous-prone cardiac disorders, such as mitral valve prolapse and mitral annular calcification was low.

[Valvular heart disease associated with benfluorex]. / Valvulopatía cardíaca asociada al uso de benfluorex.

We report the first case of valvular heart disease due to benfluorex. A 50-year-old woman who had been taking the anorectic agent benfluorex intermittently for one year developed severe fibrosis and regurgitation of the mitral, aortic and tricuspid valves. Clinical, echocardiographic and histopathological findings were analogous to those reported with fenfluramine and dexfenfluramine. The similarity between the histopathological lesion documented in patients treated with the appetite suppressants fenfluramine, dexfenfluramine and benfluorex and the valvular lesions reported in valve disease associated with ergot alkaloid use and carcinoid heart disease suggest a common pathophysiological mechanism and a central role for serotonin in the development of the disease.

Valvulopatía cardíaca asociada al uso de benfluorex / Valvular heart disease associated with benfluorex

Presentamos un caso asociado al tratamiento con benfluorex, con fibrosis tetravalvular subaguda que inducía intensa regurgitación mitral, aórtica y tricuspídea, además de moderada insuficiencia pulmonar. Las características clínicas, ecocardiográficas e histológicas del cuadro son análogas a las descritas con fenfluramina y dexfenfluramina, por lo que debería añadirse el benfluorex a la lista de fármacos anorexígenos que pueden inducir valvulopatía. La similitud entre la histopatología valvular hallada en los pacientes tratados con estos tres tipos de anorexígenos serotoninérgicos y la asociada al consumo de alcaloides ergotamínicos y a la cardiopatía carcinoide hacen pensar en la existencia de un mecanismo fisiopatológico común y un papel central de la serotonina como mediador de la lesión valvular. (AU)