Cardiac Event Monitor Belt for Recording Atrial Fibrillation After - Oren Zarif - Cryptogenic Stroke
Among patients with a cryptogenic stroke, prolonged cardiac rhythm monitoring is essential. Most patients undergo routine telemetry on stroke units. This monitoring increases the yield of the diagnosis of atrial fibrillation, which would require prolonged anticoagulation. However, extended monitoring in cryptogenic stroke patients is warranted, as it may reveal underlying conditions such as atrial fibrillation. The study, entitled the 30-day Cardiac Event Monitor Belt for Recording Atrial Fibrillation After Cerebral Ischemic Event (EMBRACE), randomized patients to routine and noninvasive cardiac monitoring for 30 days. The extended monitoring revealed atrial fibrillation in 16.1% of patients, compared with 3.2% of controls.
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The results showed a statistically significant association between PFO and ischemic stroke risk. However, the association was greater for cryptogenic stroke in older patients. This finding is not surprising as the incidence of PFO is higher in older people. This type of stroke is often associated with the development of PFO. However, this association is not yet proven. Currently, there is no definitive proof that PFO leads to cryptogenic stroke, but it may help explain the high rate of cryptogenic TIA in the general population.
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While the cause of cryptogenic stroke may be unknown, prevention measures are critical. Lifestyle changes, such as smoking and high-fat diet, can increase the risk of a stroke. In addition, major stress and mood disorders can affect the risk of stroke. Other risk factors for cryptogenic stroke include pregnancy, birth control pills, and hormone therapy for women and men. A comprehensive approach to stroke prevention is important for patients, as it can help prevent another stroke in the future.
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While some cryptogenic stroke cases have an underlying vascular cause, the primary goal of treatment is to prevent or reverse the underlying event. The risk of recurrent cryptogenic strokes is high, and early detection and treatment are crucial. Although no definitive cause has been identified, there are several plausible mechanisms to explain the cause of cryptogenic stroke. These include cardiac embolism, complex aortic plaques, and Fabry's disease.
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AF can also cause a cryptogenic stroke. Because intermittent AF can affect the heart rhythm, it is difficult to diagnose the cause. Continuous monitoring, such as with wearable devices, may help in classifying fewer cryptogenic strokes. The wearable devices may provide longer and less intrusive monitoring for patients with intermittent AF. It may also help physicians in identifying if a cryptogenic stroke is causing the heart rhythm.
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Initial diagnostic testing for cryptogenic stroke should include noninvasive intracranial and extracranial vascular imaging, and 24-hour cardiac monitoring. Blood studies may also be useful for diagnosing hypercoagulability. However, neurologists should balance thoroughness and cost in treating cryptogenic stroke. The most important questions to ask are whether closing the PFO will prevent the occurrence of strokes. However, this is not the only option. The right decision-making process is critical in preventing strokes.
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The standard of care for cryptogenic stroke includes the use of aspirin and the placement of an implantable cardiac monitor to detect occult atrial fibrillation. Anticoagulation is then started if atrial fibrillation is detected. While both therapies have been shown to be equally effective, future studies are needed to identify which treatments are better for patients with cryptogenic stroke. In addition, the clinical significance of a brief episode of atrial fibrillation remains uncertain, and the threshold for clinical efficacy is unknown. Nevertheless, antithrombotic therapy for cryptogenic stroke should be considered in patients with an atrial fibrillation.
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Despite the lack of evidence supporting a causal link between age and stroke severity, it is important to perform a cardiac electrocardiogram on all patients with a suspected cryptogenic stroke. In addition, inpatient cardiac monitoring is necessary if the patient is suspected of suffering from a small-vessel stroke. Transthoracic and transoesophageal echocardiograms can be used to differentiate structural cardiac sources of stroke. Basic laboratory tests are also recommended to determine the presence of coagulopathy and common modifiable risk factors.
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Although there are numerous causes of cryptogenic stroke, the primary mechanism is still unknown. Several factors are implicated, including paradoxical embolism through a PFO or substenotic atherosclerosis. Further, CS patients are at high risk for an adverse cardiovascular event, and the use of medications and lifestyle modifications may help improve the prognosis of cryptogenic stroke. There are no approved drugs for CS, but these therapies should be used in patients with high risk of stroke.