Heart-Brain Interactions

224 Pages·1992·11.957 MB·English

by  M. Pagani, P. Pizzinelli, D. Lucini, A. Malliani (auth.), Giuseppe Di Pasquale M.D., Giuseppe Pinelli M.D. (eds.)

Giuseppe Di Pasquale
Giuseppe Pinelli
(Eds.)
Heart-Brain
Interactions
With 42 Figures
Springer-Verlag
Berlin Heidelberg New Yark
London Paris Tokyo
Hong Kong Barcelona Budapest
Giuseppe Di Pasquale, M.D.
Giuseppe Pinelli, M.D.
Division of Cardiology
Bellaria Hospital
Bologna, Italy
ISBN -13: 978-3-642-76654-1 e-ISBN-13: 978-3-642-76652-7
001: 1O.l007/978-3-642-76652-7
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© Springer-Verlag Berlin Heidelberg 1992
Softcover reprint of the hardcover 1st edition 1992
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Preface
In the last decade there has been a growing interest in the study of the
interactions between the heart and the brain, especially in the field of cerebral
ischemia. The interactions between cardiovascular and cerebrovascular diseases
are of relevance not only for research investigation, but also for clinical
implications in the daily clinical practice.
A wealth of information has been gathered particularly on three topics, i.e.
cardiovascular consequences of cerebral injuries, cardioembolic stroke, and
association of carotid and coronary artery disease. The available information,
however, is still sparse and fragmentary mainly because of the lack of commun
ication between neurologists and cardiologists. With the aim of improving
communication between several disciplines and technologies, we started to
organize since 1987 in Bologna, Italy, an international Symposium on heart
brain interactions to be held every 3 years. Our intention was to gather
prominent clinicians and researchers from outstanding cardiologic and neuro
logic institutions actively involved in the study of heart-brain interactions. The
ambitious goal has been to fit different pieces of information like in a puzzle.
This book originates from the contributions presented at the 2nd Sympo
sium which was held in Bologna on November 30-December 1, 1990. The book
is subdivided into three sections: I cardiovascular consequences of cerebral
damage, II cardiogenic cerebral ischemia, III cerebrovascular and coronary
artery disease.
In the first section, the role is outlined of the sympathetic and vagal system
in the modulation of heart-brain interactions. The cardiovascular consequences
of ischemic or hemorrhagic brain injuries are presented including electrocardio
graphic changes, cardiac arrhythmias, and myocardial damage. Finally, the role
of beta-blockade in the prevention of these abnormalities is discussed.
The second section includes the diagnostic and therapeutic aspects of either
global (syncope) or focal (strokefTIA) cardiogenic cerebral ischemia. Cardio
genic embolism is extensively discussed with particular emphasis on atrial
fibrillation and cardiac sources of cerebral emboli in young cerebrovascular
patients. The role of echocardiography, especially the transesophageal tech
nique, in the management of the patient with stroke is in depth analyzed.
The third section deals with the association of cerebrovascular and coronary
artery disease. The main risk factors (arterial hypertension and hyperlipidemia)
are focused. The frequency of the association of coronary and carotid artery
VI Preface
disease and the possibilities of non invasive detection are presented. The medical
options for the treatment of myocardial or cerebral ischemia (antiplatelet drugs,
heparin, and thrombolysis) are reviewed, as well as the pharmacological ap
proaches to the regression of atherosclerosis. Finally, the surgical indications to
carotid endarterectomy and the surgical strategy in patients with associated
carotid and coronary artery lesions are discussed.
The editors wish to thank all the authors who have actively and friendly
collaborated to the realization of this project. We hope that, thanks to a fruitful
interdisciplinary approach, this book could represent a further step towards a
better understanding of the interactions between the heart and the brain.
Giuseppe Oi Pasquale Giuseppe Pinelli
Contents
I Cardiovascular Consequences of Cerebral Damage
The Visceral Nervous System as a Link Between the Heart and the
Brain: An Approach Employing Spectral Analysis of R-R and Systolic
Arterial Pressure Variabilities
M. Pagani, P. Pizzinelli, D. Lucini, and A. Malliani. . . . . . .. 3
Electrocardiographic Changes Following Acute Ischemic or
Hemorrhagic Stroke
S. Sen, T. Stober, W. Thonnes, and A. Heisel. . . 13
Cardiac Arrhythmias Following Acute Brain Injuries
G. Di Pasquale, S. Urbinati, and G. Pinelli. . . . 19
Clinical Evidence of Myocardial Damage in Patients with Acute
Subarachnoid Hemorrhage
M. Emdin, G. Di Pasquale, C. Boni, S. Urbinati, G. Buzzigoli,
A.M. Lusa, G. Pinelli, and A. L'Abbate. . . . . . . . . 31
Pathologic Evidence of Myocardial Damage Following Acute Brain
Injuries
G. Baroldi . . . . . . . . . . . . . . . . . . . .. 43
Prevention of Myocardial Damage Following Acute Brain Injuries by
Beta-Blockade
J.M. Cruickshank. . . . . . . . . . . . . . . . . .. 49
II Cardiogenic Cerebral Ischemia: Diagnostic and Therapeutic Aspects
Cardiogenic Focal Cerebral Ischemia in Patients Under 45 Years
C. Fieschi, M. Frontoni, F. Orzi, A. Carolei, and the CNR Study
Group. . . . . . . . . . . . . . . . . . . . . . 59
VIII Contents
Diagnostic-Therapeutic Protocol of Syncope
E. Piccolo, A. Raviele, and G. Gasparini. . 65
Cardioembolic Stroke: Prevalence, Diagnosis, and Treatment
D.G. Sherman. . . . . . . . . . . . . . . . . 73
Thromboembolism in Nonrheumatic Atrial Fibrillation: What Have
We Learned?
R.G. Hart . . . . . . . . . . . . . . . . . . 83
Usefulness of Transthoracic, Transesophageal, and Contrast
Ecocardiography in Patients with Suspected Cardioembolic Stroke
J.R.T.e. Roelandt, and M. Pozzoli. . . . . . . . . . . . 87
Two-Dimensional Echocardiography in Young Adults with Cerebral
Ischemia: Emerging Issues
S. Urbinati, G. Di Pasquale, A. Andreoli, and G. Pinelli . . . .. 95
III Cerebrovascular and Coronary Artery Disease
1 Risk Factors
Arterial Hypertension and Risk of Stroke and Myocardial Infarction
E. Ambrosioni, and e. Borghi . . . . . . . . . . . . . . . 111
Hyperlipidemia and Risk of Stroke
M. Mancini, A. Postiglione, and L.A. Ferrara. . . . . . . . . . 117
2 Detection of Association
Noninvasive Investigation for the Detection of Asymptomatic Ischemic
Heart Disease in Cerebrovascular Patients
A.M. Lusa, S. Urbinati, G. Di Pasquale, and G. Pinelli . . .. 121
Multifocal Atherosclerotic Noninvasive Findings in Patients with
Coronary Artery Disease
E. Borgatti, A. De Fabritiis, G. Scondotto, A. Marzocchi, A. Amato,
E. Conti, M. Filippini, C. Pili, and I. Emiliani.. . . . . . . . . 139
3 Medical Treatment
Pharmacological Approaches to the Regression of Atherosclerotic
Lesions of the Carotid or Coronary Arteries
W. Schneider . . . . . . . . . . . . . . . . . . . .. 149
Contents IX
Antiplatelet Therapy and Prevention of Myocardial Ischemia
E. Geraci. . . . . . . . . . . . . . . . . . . . . . . 159
Antiplatelet Therapy in Stroke Prevention
V.C. Hachinski, R. Ivey and B. Ivey . . . . . 165
Heparin in the Treatment of Cerebral and Myocardial Ischemia
G.G. Neri Semeri, and P.A. Modesti. . . . . . . . . . 171
Thrombolytic Therapy in Acute Myocardial Infarction
B. Magnani,G. Melandri, F. Semprini, G. Labanti, and D. Pantoli . . 187
Thrombolytic Treatment of Patients with Acute Ischemic Stroke
T. Brott . . . . . . . . . . . . . . . . . . . . . . . 193
Management of Acute Ischemic Stroke
H. P. Adams . . . . . . . . . . . . . . . . . . . . . 199
4 Surgical Treatment
Carotid Endarterectomy: Wider Indications or Better Selection?
A. Andreoli, G. Lanzino, P. Limoni, E. Pozzati, and F. Tognetti . 209
Surgical Strategy in Patients with Associated Carotid and Coronary
Artery Lesions: Staged or Combined Operations?
G. Marinelli, B. Turinetto, M. Cazzato, and A. Pierangeli. . . .. 221
Subject Index . . . . . . . . . . . . . . . . 225
Main authors
H.P. Adams, Jr., M.D.
Division of Cerebrovascular Diseases, Department of Neurology,
University of Iowa College of Medicine, Iowa City, Iowa, 52242, USA
Prof. E. Ambrosioni
Istituto di Clinica Medica III, Policlinico S. Orsola,
Via Massarenti 9, 1-40138 Bologna, Italy
A. Andreoli
Neurosurgical Department, Bellaria Hospital,
1-40138 Bologna, Italy
Prof. G. Baroldi
Istituto Fisiologia Clinica CNR, Sezione di Milano, Dipartimento Cardiologico
"A. De Gasperis", Ospedale Niguarda Ca' Granda, Pizza Ospedale Maggiore 3,
20162 Milano, Italy
Prof. E. Borgatti
Department of Angiolugy, S. Orsola-Malpighi Hospital,
1-40138 Bologna, Italy
T. Brott, M.D.
Department of Neurology, University of Cincinnati College of Medicine,
231 Bethesda Avenue, Cincinnati, Ohio 45267-0525, USA
Dr. J.M. Cruickshank
Medical Research Department, ICI Pharmaceuticals, Mereside, Aldedey Park,
Macclesfield, Cheshire, SK10 4TG, England
Dr. M. Emdin
Istituto di Fisiologia Clinica del CNR,
Via Savi 8, 1-56100 Pisa, Italy
C. Fieschi
3rd Cattedra di Clinica Neurologia, Dipartimento di Scienze Neurologiche,
Universita degli Studi di Roma "La Sapienza", Rome, Italy
E. Geraci, M.D.
Via De Gasperi, 30, 90146 Palermo, Italy
XII Main authors
Dr. V.c. Hachinski
Department of Clinical Neurological Sciences, University Hospital,
339 Windermere Road, London, Ontario N6A 5A5, Canada
R.G. Hart, M.D.
Department of Medicine (Neurology), University of Texas,
San Antonio, TX 78284-7883, USA
A.M. Lusa, M.D.
Sezione di Cardiologia, Ospedale Bellaria,
Via Altura 3, 1-40139 Bologna, Italy
Prof. B. Magnani
Istituto di Malattie dell'Apparato Cardiovascolare Universita,
Policlinico S. Orsola, Via Massarenti n. 9, 40138 Bologna, Italy
M. Mancini
Institute of Internal Medicine and Metabolic Diseases,
2nd Faculty of Medicine, University of Naples, Via S. Pansini 5,
80131 Naples, Italy
Dr. G. Marinelli
Divisione di Cardiochirurgia, Policlinico S. Orsola,
Via Massarenti, 9, 40138 Bologna, Italy
M. Pagani, M.D, F ACC
Istituto Ricerche Cardiovascolari, Via Bonfadini 214,
20138 Milano, Italy
E. Piccolo
Divisione di Cardiologia, Ospedale Umberto I
Mestre (Venezia), Italy
J.R.C.T. Roelandt, M.D.
Thoraxcentre, Bd 408, P.O. Box 1738,
3000 DR, Rotterdam, The Netherlands
Dr. Med. W. Schneider, P.D.
Zentrum der Inneren Medizin, Abteilung fUr Kardiologie,
Klinikum der Johann Wolfgang Goethe-Universitat,
Theodor-Stern-Kai 7, D-6ooo Frankfurt a.M. 70, Germany
Dr. S. Sen
Medizinische Universitatsklinik, Innere Medizin III,
6650-Homburg/Saar, Germany
G.G. Neri Serneri
Clinica Medica I, University of Florence,
Viale Morgagni 85, 50134 Florence, Italy