title: Neurologic complications of cardiomyopathies and other myocardial disorders.
abstract: Cardiomyopathies have a variety of causes: infectious, genetic, valvular heart disease, coronary artery disease, hypertension, and tachycardias. All can result in myocardial dysfunction and often congestive heart failure. The main interaction between a diagnosis of heart disease and the brain is via embolic stroke. The focus here is on myocardial dysfunction. Thrombus is associated with myocardial dysfunction and depressed left ventricular ejection fractions. Reduced left ventricular ejection fractions and mural thrombus are associated with embolic strokes. Atrial fibrillation is a primary source of thrombi. Anticoagulation can significantly reduce the incidence of thrombotic problems. Patent foramen ovale has created interest in those patients with cryptogenic strokes. Cryptogenic strokes are associated with patent foramen ovales, although not all cryptogenic strokes are associated with paradoxical emboli. Clinically silent cerebral infarctions occur in patients with dilated cardiomyopathy as detected by multidetector computed tomography or magnetic resonance imaging studies. Left ventricular dysfunction from cardiomyopathies is associated with mural thrombi, but the prevalence of embolic stroke varies widely from 3% to 50%; as many as half of embolic strokes are related to atrial fibrillation. Nonvalvular atrial fibrillation can increase the risk of stroke by a factor four to seven times when compared to normal sinus rhythm. Stroke risks and bleeding risks with anticoagulation can be estimated by scores. Genetic abnormalities are increasing in importance in helping to find the etiology and inheritance of some dilated cardiomyopathies. Careful clinical evaluation remains important.
authors.affiliation: Division of Cardiology, Loyola University Medical Center, Maywood, IL, USA. Electronic address: JMORAN4@lumc.edu.
authors.forename: John F
authors.initials: JF
authors.lastname: Moran
mesh_terms: D009202:Cardiomyopathies / Q000145:classification / Q000150:complications*; D006331:Heart Diseases; D006801:Humans; D009422:Nervous System Diseases / Q000209:etiology*; D012307:Risk Factors
keywords: Embolic stroke; atrial fibrillation; cardiomyopathy; left ventricular dysfunction; patent foramen ovale