Navigating the Complexities of Stroke by Caplan Louis R

Author:Caplan, Louis R.
Language: eng
Format: epub
Publisher: Oxford University Press, USA
Published: 2013-09-14T16:00:00+00:00

Heart Tests

Heart testing is useful in almost all patients with stroke. The heart often acts as a source of clot formation, and clots and fragments of heart valves can break off and embolize to the brain, causing strokes. Individuals who have narrowing of the large arteries in the neck that supply blood to the brain often also have narrowing of the arteries that supply the heart muscle (the coronary arteries).

Electrocardiograms (EKGs) have long been used to study the heart. They show the rate at which the heart is beating (the pulse rate) and identify heart rhythm abnormalities. This simple, familiar test can also show the evidence of past heart attacks. Robert H’s electrocardiogram showed evidence of a previous heart attack, but his heart rhythm was normal. Elaine S.’s EKG showed atrial fibrillation. In Tom M., the EKG showed evidence of enlargement of the left-side heart muscle (left ventricular hypertrophy) caused by his hypertension. Claire H. had a normal EKG.

Ultrasound of the heart (called echocardiography) can yield pictures of the various parts of the heart and their functioning. It is performed by a technician or a cardiologist, who places an ultrasound probe on the chest or has the patient swallow a string-like device containing an ultrasound probe that travels into the esophagus. Much of the heart can be seen better from the back through the esophagus than from the front. The cardiologist can see the heart valves, the upper heart chambers (atria), and the left and right ventricles. Sometimes saline bubbles are injected into an arm vein to see their passage through the heart. In patients who have atrial and ventricular septal defects and PFOs, the bubbles can pass from the right side of the heart to the left chambers. In Robert H. the echocardiogram showed a region of impaired contraction where he had had a myocardial infarction. In Elaine S., the echocardiogram showed a thrombus within the left atrium of the heart (Figure 9-10).

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