Management of cerebral embolism of cardiac origin

Abstract

The cardiac conditions most commonly associated with cerebral embolism are rheumatic heart disease (RHI), atherosclerotic heart disease (myocardial infarction and atrial arrhythmias) and other kinds of nonvalvular atrial fibrillation (AF). The natural history of cerebral embolism from these cardiac sources is reviewed. Virtually all rheumatic hearts producing emboli hare mitral stenosis, bill not all of them are in AF. Of patients with RHD, 10-20% will experience a systemic embolus, and approximately half will hare a recurrence, usually early. Of patients with a myocardial infarction, 5-12% will have a clinically apparent systemic embolus, and one-third to one-half have a recurrence, usually early. As many as 10-20% of patients with non-rheumatic AF have a systemic embolus. Anticoagulation reduces systemic embolism to 10-20% of the natural incidence in RHD, and it reduces embolle recurrences to 10-20% of the natural recurrence rate. Anticoagulation diminishes the incidence of emboll In myocardial Infarction to 25% of the natural Incidence. It is not known what effect anticoagulation has on the incidence of embolism hi nonrbeumatic AF. The data regarding the effect of valvulotomy and prosthetic valve placement in RHD are briefly reviewed. Recommendations are made for the use and timing of anticoagulation based on the available data. © 1980 American Heart Association, Inc.