Prolonged Cardiac Monitoring Increases Chances of Early Detection - Oren Zarif - Cryptogenic Stroke

In a patient with a cryptogenic stroke, prolonged rhythm monitoring increases the likelihood of early detection and better treatment options. While most patients undergo telemetry on stroke units, prolonged outpatient monitoring can increase the yield of detection. Patients with AF may require long-term anticoagulation, which complicates the diagnosis of cryptogenic stroke. The 30-day Cardiac Event Monitor Belt for Recording Atrial Fibrillation After Cerebral Ischemia (EMBRACE) trial randomized patients to noninvasive cardiac monitoring for 30 days. Patients with cryptogenic stroke showed a higher percentage of detection than control patients, and the extended monitoring period reduced the risk of long-term anticoagulation.

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In the DEFENSE-PFO trial, patients with high-risk PFO were enrolled. Inclusion criteria included cryptogenic stroke and atrial septal aneurysm, as well as hypermobility or PFO size. The patients were randomized to receive medical therapy, either PFO closure or antiplatelet therapy alone. A total of 4 trials showed that patients who had a PFO had a lower risk of recurrent ischemic stroke compared with those who received antiplatelet or warfarin therapy alone.

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In addition to monitoring the heart, the severity of a cryptogenic stroke can be determined by the presence of silent AF. A diagnosis of silent AF is critical for proper therapy. In most patients, sBNP concentrations are elevated, and oral anticoagulation should be initiated. Nevertheless, there is no consensus regarding the role of this biomarker in cryptogenic stroke. The study findings have to be confirmed through further research. Despite the many potential benefits of a cryptogenic stroke biomarker, it is not clear whether the treatment will help in patients with AF.

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While a PFO has been linked to a high risk of recurrent stroke, there is no direct causal connection. However, it is important to note that PFO is a common condition in the general population. Thus, it is imperative to check for this factor in patients with cryptogenic stroke. It is also essential to check for a PFO in patients with ASA. This way, patients with cryptogenic stroke can avoid having a pseudothrombotic stroke.

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Researchers have concluded that the risk of developing cryptogenic stroke is higher in younger patients and ethnic minorities. In fact, in Finland, a higher percentage of cryptogenic stroke was observed in young adults, compared to older patients. Interestingly, ischemic stroke incidence is higher among minority groups than among whites, and the risks of recurrence are lower. In other countries, the prevalence of cryptogenic stroke may be higher. This finding should prompt a revised definition of cryptogenic stroke. However, further research is needed to determine whether this underlying event is a risk factor and a potential clinical strategy.

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The Scripps Cryptogenic Stroke Program is located on the La Jolla campus of Scripps Memorial Hospital. This campus includes the Prebys Cardiovascular Institute and the John R. Anderson V Medical Pavilion. The Prebys Cardiovascular Institute is a comprehensive heart care center. It has 90 years of history of medical breakthroughs and is one of the largest cardiovascular medicine facilities on the West Coast. Although there is little evidence to support empiric anticoagulation in cryptogenic stroke, it has been recommended for patients who present with atrial fibrillation in the past.

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Cardioembolic mechanisms have been discussed extensively in recent years. While they are unlikely to lead to cryptogenic stroke, they are thought to be a possible etiology. Patients with this condition may have no symptoms or only experience a stroke when they have an irregular heartbeat. Having a regular heart monitor can help doctors determine if your condition is the cause of the stroke and take steps to prevent future complications. There are also various medications that may increase the risk of cryptogenic stroke.

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The TCD is an important diagnostic test for cryptogenic stroke, although it is limited in its ability to reveal cardiac structures. If TCD is positive, a right-to-left shunt may be the cause of cryptogenic stroke. Further imaging may be needed to confirm a diagnosis. When this occurs, TEE is recommended. If TEE is positive, an aortic arch examination should be performed. Alternatively, MRI can also be used to confirm if cryptogenic stroke is the cause.

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The PELVIS study involved a group of patients aged 18 to 60 years, who underwent MRI venography within 72 h of the cryptogenic stroke. Twenty percent of these patients had a thrombus. The PELVIS study included more than 1,000 patients. And, it also concluded that there was a higher risk of recurrent cryptogenic stroke. There is also a possibility that the patient may have occult atrial fibrillation or heart rhythm disorder, which could contribute to the onset of the stroke.