Volume : 10, Issue : 05, May – 2023
04.INCIDENCE OF MYOCARDIAL INFARCTION AMONG KNOWN PATIENTS OF ISCHEMIC STROKE
Pooja Bai, Manisha Lohana, Munesh Kumar, FNU Saveeta, Aanand Kumar Lohana, Ahmed Qudoos
Background Acute myocardial infarction in individuals who have had a cerebrovascular accident or transient ischemic attack (CVA-TIA) is a medical emergency, which must be examined and treated as soon as possible. Physicians face a significant problem in managing this scenario because early treatment of one ailment would surely postpone treatment of the other. Early detection and treatment will have an impact on the patient’s morbidity and mortality in the future, as well as aid in the patient’s rehabilitation.
Objective: To determine the incidence of myocardial infarction among known patients of Ischaemic stroke. Methodology: This prospective observational study was conducted on 103 patients who presented with stroke at the medicine outpatient department of Liaquat University Hospital (Hyderabad). On the basis of ECG alterations and cardiac biomarkers, Myocardial Infarction was diagnosed among patients who presented with altered sensorium. The diagnosis of stroke/TIA was based on the onset of a localized neurological loss that lasted for at least 24 hours (stroke) or recovering earlier (TIA). A CT/MRI scan of the brain was performed for a definitive diagnosis to identify ischemia/hemorrhage as the cause of ischeamic stroke.
Results: According to the age-based distribution, the highest rate of myocardial infarction (8%, 8) was observed in those aged 51-60 years. The male-to-female ratio is 1.86:1. Thirty-two patients had diabetes, among them 75% had only elevated creatine kinase MB (CKMB) with no myocardial infarction (MI), whereas 59 patients had hypertension of which 70% had only elevated CK-MB with no MI. ST-elevation myocardial infarction (STEMI) with high CKMB accounted for 14.78% (15) of the cases, but the majority (71%, 73) of the cases had elevated CKMB with no MI, and the rest presented with normal CKMB.
Conclusion: The study reported that the incidence of MI among patients of Ischaemic Stroke was found to be higher than that of the general population. This finding highlights the need for increased vigilance and monitoring for MI in this patient population. Keywords: Acute Myocardial Infarction, ST-Elevation Myocardial Infarction (STEMI), CK- MB, Transient Ischemic Attacks, Cerebro-Vascular Accident
Cite This Article:
Please cite this article in press Pooja Bai et al, Incidence of Myocardial Infarction among known patients of Ischemic Stroke.,Indo Am. J. P. Sci, 2023; 10 (05).
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1. Hyperacute simultaneous cardiocerebral infarction: rescuing the brain or the heart first? Kijpaisalratana N, Chutinet A, Suwanwela NC. Front Neurol. 2017;8:664
2. Quantifying the risk of heart disease following acute ischaemic stroke: a meta-analysis of over 50,000 participants. Gunnoo T, Hasan N, Khan MS, Slark J, Bentley P, Sharma P. BMJ Open. 2016;6:0.
3. The incidence of stroke after myocardial infarction: a meta-analysis. Witt BJ, Ballman KV, Brown RD Jr, Meverden RA, Jacobsen SJ, Roger VL. Am J Med. 2006;119:354.
4. Incidence and predictors of myocardial infarction after transient ischemic attack: a population-based study. Burns JD, Rabinstein AA, Roger VL, Stead LG, Christianson TJ, Killian JM, Brown RD Jr. Stroke. 2011;42:935–940.
5. Myocardial infarction as a complication in acute stroke: results from the Austrian stroke unit registry. Gattringer T, Niederkorn K, Seyfang L, et al. Cerebrovasc Dis. 2014;37:147–152.
6. Coronary risk evaluation in patients with transient ischemic attack and ischemic stroke: a scientific statement for healthcare professionals from the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/American Stroke Association. Adams RJ, Chimowitz MI, Alpert JS, Awad IA, Cerqueria MD, Fayad P, Taubert KA. Circulation. 2003;108:1278–1290.
7. Inclusion of stroke as an outcome and risk equivalent in risk scores for primary and secondary prevention of vascular disease. Dhamoon MS, Elkind MS. Circulation. 2010;121:2071–2078.
8. Myocardial infarction and stroke. Komrad MS, Coffey CE, Coffey KS, McKinnis R, Massey EW, Califf RM. Neurology. 1984;34:1403–1409.
9. Cerebrovascular accident complicating acute myocardial infarction: incidence, clinical significance, and short-long-term mortality rates. Behar S, Tanne D, Abinader E, et al. Am J Med. 1991;91:45–50.
10. Prevalence of asymptomatic coronary artery disease in ischemic stroke patients: the
PRECORIS study. Calvet D, Touzé E, Varenne O, Sablayrolles JL, Weber S, Mas JL. Circulation. 2010;121:1623–1629.
11. Myocardial infarction coincident with cerebrovascular accidents in the elderly. Chin PL, Kaminski J, Rout M. Age Ageing. 1977;6:29–37.
12. Autopsy prevalence of coronary atherosclerosis in patients with fatal stroke. Gongora-Rivera F, Labreuche J, Jaramillo A, Steg PG, Hauw JJ, Amarenco P. Stroke. 2007;38:1203–1210.
13. Feasibility study of stroke surveillance: data from Bangalore, India. Nagaraja D, Gururaj G, Girish N, Panda S, Roy AK, Sarma GRK, Srinivasa
R. https://pubmed.ncbi.nlm.nih.gov/19942742/ I ndian J Med Res. 2009;130:396–403.
14. Study of ECG changes and its relation to mortality in cases of cerebrovascular accidents. Purushothaman S, Salmani D, Prarthana KG, Bandelkar SM, Varghese S. J Nat Sci Biol Med. 2014;5:434–436.
15. Coronary angiographic findings in acute ischemic stroke patients with elevated cardiac troponin: the troponin elevation in acute ischemic stroke (TRELAS) study. Mochmann HC, Scheitz JF, Petzold GC, et al. Circulation. 2016;133:1264– 1271.
16. The insular cortex and cardiovascular system: a new insight into the brain-heart axis. Nagai M, Hoshide S, Kario K. J Am Soc Hypertens. 2010;4:174–182.
17. Neuroanatomic correlates of stroke-related myocardial injury. Ay H, Koroshetz WJ, Benner T, et al. Neurology. 2006;66:1325–1329.
18. The insular cortex and cardiac response to stroke. Cheshire WP Jr, Saper CB. Neurology. 2006;66:1296–1297.
19. Relation between troponin T concentration and mortality in patients presenting with an acute stroke: observational study. James P, Ellis CJ, Whitlock RM, McNeil AR, Henley J, Anderson NE. BMJ. 2000;320:1502–1504.
20. Cardiac troponins and N-terminal pro-brain natriuretic peptide in acute ischemic stroke do not relate to clinical prognosis. Etgen T, Baum H, Sander K, Sander
D. https://pubmed.ncbi.nlm.nih.gov/15604421/ S troke. 2005;36:270–275.
21. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Adams HP Jr, del Zoppo G, Alberts MJ, et al. Stroke. 2007;38:1655–1711.
22. Elevated troponin after stroke: a systematic review. Kerr G, Ray G, Wu O, Stott DJ, Langhorne P. Cerebrovasc Dis. 2009;28:220– 226.
23. National Collaborating Centre for Chronic Conditions. London: Royal College of Physicians; 2008. Stroke: National Clinical Guideline for Diagnosis and Initial Management of Acute Stroke and Transient Ischaemic Attack (TIA).