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Нарушения ритма сердца и инсульт
Петрова Е.А., Кольцова Е.А. Нарушения ритма сердца и инсульт. Consilium Medicum. 2017; 19 (2): 30–34.
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Petrova E.A., Koltsova E.A. Cardiac arrhythmias and stroke. Consilium Medicum. 2017; 19 (2): 30–34.
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Аннотация
В статье обсуждается роль нарушений сердечного ритма в развитии разных типов ишемического инсульта. В патогенезе кардиоэмболического инсульта важное и самостоятельное значение имеет пароксизмальная форма мерцательной аритмии. В развитии гемодинамического инсульта одним из решающих факторов являются транзиторная брадиаритмия вследствие атриовентрикулярной блокады и синдрома слабости синусового узла, а также ухудшение сократимости левого желудочка, обусловленное преходящей ишемией миокарда. Показано, что брадиаритмия и желудочковая экстрасистолия, сопряженные с высоким риском коронарных осложнений и опасные для жизни больного, могут не коррелировать с выраженностью неврологического дефицита. У больных с кардиогенным ишемическим инсультом почти в 40% случаев патогенетически значимые сердечные аритмии протекают асимптомно. Возможность скрытого течения нарушений сердечного ритма и эпизодов ишемии миокарда, выявление их в ряде случаев только после развития неврологической симптоматики и влияние на течение заболевания определяют важность своевременной регистрации данных изменений для оптимизации лечебной тактики.
Ключевые слова: ишемический инсульт, кардиоцеребральная эмболия, мерцательная аритмия, брадиаритмия, минутный объем сердца, холтеровское мониторирование.
Ключевые слова: ишемический инсульт, кардиоцеребральная эмболия, мерцательная аритмия, брадиаритмия, минутный объем сердца, холтеровское мониторирование.
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In this paper we discussed the role of cardiac arrhythmias in the development of different types of ischemic stroke. In the pathogenesis of cardioembolic stroke the main role plays paroxysmal atrial fibrillation. Haemodynamic stroke can be caused by transient bradyarrhythmia due to the atrioventricular block and sick sinus syndrome, as well as the transient myocardial ischemiawith the deterioration of left ventricular contractility. It has been shown, that bradyarrhythmia and ventricular extrasystolesare associated with high risk of development of life-threatening acute coronarysyndrome, and may not correlate with the severity of the neurological deficit. In patients with cardioembolic stroke in 40% of cases cardiac arrhythmiasand episodes of myocardial ischemiawith pathogenetic significance have asymptomatic clinical course and are usually diagnosed only after the development of neurological symptoms. Thus, time lyregistration of hidden heart problems is crucial for optimization of treatment strategy.
Key words: ischemic stroke, cardio-cerebral embolism, atrial fibrillation, bradyarrhythmia, cardiac minute volume, Holter ECG.
Key words: ischemic stroke, cardio-cerebral embolism, atrial fibrillation, bradyarrhythmia, cardiac minute volume, Holter ECG.
Полный текст
Список литературы
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16. Фонякин А.В., Гераскина Л.А., Суслина З.А. Соотношение размера церебрального ишемического очага и места формирования эмбологенного субстрата при кардиоэмболическом инсульте. Неврологический журн. 2003; 1: 10–3. / Foniakin A.V., Geraskina L.A., Suslina Z.A. Sootnoshenie razmera tserebral'nogo ishemicheskogo ochaga i mesta formirovaniia embologennogo substrata pri kardioembolicheskom insul'te. Nevrologicheskii zhurn. 2003; 1: 10–3. [in Russian]
17. Шевченко Ю.Л., Одинак М.М., Кузнецов А.Н., Ерофеев А.А. Кардиогенный и ангиогенный церебральный ишемический инсульт. М.: ГЭОТАР-Медиа, 2006; с. 127–36. / Shevchenko Iu.L., Odinak M.M., Kuznetsov A.N., Erofeev A.A. Kardiogennyi i angiogennyi tserebral'nyi ishemicheskii insul't. M.: GEOTAR-Media, 2006; s. 127–36. [in Russian]
18. Школьникова М.А., Харлап М.С., Ильдарова Р.А. Генетически детерминированные нарушения ритма сердца. Рос. кардиологический журн. 2011; 1 (87). / Shkol'nikova M.A., Kharlap M.S., Il'darova R.A. Geneticheski determinirovannye narusheniia ritma serdtsa. Ros. kardiologicheskii zhurn. 2011; 1 (87). [in Russian]
19. Adams RJ, Albers G, Alberts MJ et al. American Heart Association American Stroke Association (2008) Update to the AHA/ASA recommendations for the prevention of stroke in patients with stroke and transient ischemic attack. Stroke 2008; 39: 1647–52.
20. Rautaharju PM, Surawic B, Gettes LS. AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram Part IV. J Am Coll Cardiol 2009.
21. Ankerman M. Cardiac causes of sudden unexpected death in children and their relationship to seizures and syncope: genetic testing for cardiac electropathies. Semin Pediatr Neurol 2005; 12: 52–8.
22. Antzelevitch C, Burashnikov A, Di Diego J. Mechanisms Cardiac Arrhythmia 2008; p. 65–133.
23. Bogousslavsky J, Regli F. Ischemic stroke in adults younger than 30 year of age. Ibid 1987; 44: 479–82.
24. Bogousslavsky J, van Melle G, Regli F. The Laussanne Stroke Registry: analysis of 1000 consecutive patients with first stroke. Stroke 1988; 19: 1083–92.
25. Botto N, Spadoni I, Giusti S et al. Prothrombotic mutations as risk factors for cryptogenic ischemic cerebrovascular events in young subjects with patent foramen ovale. Stroke 2007; 38 (7): 2070–3.
26. Caplan LR. Brain embolizm, revisited. Neurology 1993; 43: 1281–7.
27. Corbalon R, Tapia J, Braun S et al. Multidisciplinary study of cerebrovascular disorders. Cardiovascular profile of occlusive vascular disorders. Rev Med Chil 1994; 122 (9): 1021–30.
28. Deedwania P, Carbajal E. Silent ischemia during daily life is an independent predictor mortality in stable angina. Circulation 1990; 81.
29. Delcker A, Diener HC. Neurological diagnosis and therapeutic measures in cerebral emboliz. Herz 1991; 16: 434–43.
30. Engberding R, Stollberger C, Ong P et al. Isolated Non-Compaction Cardiomyopathy Dtsch Arztebl Int 2010; 107 (12): 206–13.
31. Flossman E, Schulz UG, Rothwell PM. Systematic review of methods and results of studies of the genetic epidemiology of ischemic stroke. Stroke 2004; 35: 212–27.
32. Adams HP, del Zoppo G, Alberts MJ et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association American Stroke Association Stroke Council. Stroke 2007; 38: 1655–711.
33. Hanna JP, Furlan AJ. Cardiac disease and embolic sources. Brain Ischemia: Basic Concepts and Clinical Relevance. Ed. L.R.Caplan. London, 1995; p. 299–315.
34. Hedley PL, Jorgensen P, Schlamowitz S et al. The genetic basis of long QT and short QT syndromes: a mutation update. Hum Mutation 2009; 30 (11): 1486–511.
35. Jousilahti P, Rastenyte D et al. Parental history of cardiovascular disease and risk of stroke. A prospective follow-up of 14371 middle-aged men and women in Finland. Stroke 1997; 28: 136–46.
36. Kim JA, Lopes CM, Moss AJ et al. Trigger-specific risk factors and response to therapy in long QT syndrome type 2. Heart Rhythm 2010; 7 (12): 1797–805.
37. Koennecke HC, Mast H, Trocio SS et al. Microemboli in patients with vertebrobasilar ischemia: association with vertebrobasilar and cardiac lesions. Stroke 1997; 28 (3): 593–6.
38. Lingren A, Roijer A, Rudling O et al. Cerebral lesions on magnetic resonance imaging, heart disease, and vascular risk factors in subjects without stroke – a population-based study. Stroke 1994; 25: 929–34.
39. Marcus H. Genes of stroke. J Neurol Neurosurg Psychiatry 2004; 75: 1229–31.
40. Mendel T, Jura E, Mizgalska J, Zambrovska A. Demonstration of cardiac arrhythmias in multi-infarct dementia and ischemic astroke using Holter monitoring. Neurol Neurochir Pol 1992; 26 (5): 605–11.
41. Meier B, Lock JE. Contemporary Management of Patent Foramen Ovale. Circulation 2003; 7 (14): 5–9.
42. Meschia JF. Clinically translated ischemic stroke genomics. Stroke 2004; 35 (Suppl. 1): 2735–9.
43. Messe SR, Silverman IE, Kizer JR et al. Practise parameter: recurrent stroke with patent foramen ovale and atrial septal aneurysm: report of the Quality Standarts Subcommittee of the American Academy of Neurology. Neurology 2004; 62 (7): 1042–50.
44. Mohr JP. Classification of strokes: Experience from Stroke Data Banks. Basel, 1994; p. 1–13.
45. Olshausen KV, Witt T. Sudden cardiac death while wearing a Holter monitoring. Am J Cardiol 1991; 67.
46. Overel JR, Bone I, Lees KR. Interatrial septal abnormalities and stroke: a meta-analysis of case-control studies. Neurology 2000; 55: 1172–9.
47. Page RL, Wilkinson WE, Clair WK et al. Asymptomatic arrhythmias in patients with symptomatic paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia. Circulation 1994; 89 (1): 224–7.
48. Priori SG, Antzelevitch C. Inherited arrhythmogenic diseases. In Sudden Cardiac Death. Ed. by S.G.Priori, D.P.Zipes. 2006.
49. Rothrock JF, Dittrich HC, Freck P et al. Mitral valve prolapse and ischemic stroke in the young. Circulation 1998; 78: 601.
50. Rubattu S, Gigante B, Stanzione R et al. In the search for stroke genes: a long and winding road. Am J Hypertens 2004; 17: 197–202.
51. Schimpf R, Wolpert C, Gaita F et al. Short QT syndrome. Cardiovasc Res 2005; 67: 357–64.
52. Stein JH, Soble JS. Thrombus associated with mitral valve calcification. A possible mechanism for embolic stroke. Stroke 1995; 26: 1697–9.
53. Streifler JI, Katz M. Cardiogenic cerebral emboli: diagnosis and treatment. Cur Opin Neurol 1995; 8: 45–54.
54. Winkle RA, Rodriguez J, Bragg-Remschel DA. Technological status and problems of ambulatory electrocardiographic monitoring. In: Clinical pharmacology of cardiac antiarrhythmic agents. New York, 1984; p. 108–16.
55. Yeung A, Barry I. Effects of asymptomatic ischemia of long-term prognosis in chronic stable coronary disease. Circulation 1991; 83.
56. Zipes DP, Jalife J. Cardiac electrophysiology. From cell to bedside. Elsevier. Fifth edition. 2009. Ventricular arrhythmias: mechanisms, features, and, management; p. 675–99, 723–79.
________________________________________________
1. Bokeriia L.A. Profilaktika insul'ta pri fibrilliatsii predserdii. Annaly aritmologii. 2005; 3: 45–55. [in Russian]
2. Vereshchagin N.V., Borisenko V.V., Milovidov Iu.N., Gulevskaia T.S. Kardionevrologiia: problema kardiogennoi tserebral'noi embolii (obzor zarubezhnoi literatury). Nevrologiia i psikhiatriia. 1993; 2: 90–6. [in Russian]
3. Dobrynina L.A., Kalashnikova L.A., Botvin I.M. Ishemicheskie narusheniia mozgovogo krovoobrashcheniia i kardiogennaia emboliia pri antifosfolipidnom sindrome. Trudy I Natsional'nogo Kongressa «Kardionevrologiia». Pod red. M.A.Piradova, A.V.Foniakina. M., 2008; s. 320. [in Russian]
4. Zadionchenko V.S., Ialymov A.A., Shekhian G.G., Shchikota A.M. EKG-diagnostika narushenii funktsii avtomatizma sinusovogo uzla, zameshchaiushchikh kompleksov i ritmov. RMZh. 2016; 9: 530–9. [in Russian]
5. Zamergrad M.V. Sosudistoe golovokruzhenie. RMZh. 2007; 9: 769. [in Russian]
6. Insul't. Rukovodstvo dlia vrachei. Pod red. L.V.Stakhovskoi, S.V.Kotova. M.: Meditsinskoe informatsionnoe agentstvo, 2014. [in Russian]
7. Kalashnikova L.A., Dobrynina L.A. Ishemicheskii insul't v molodom vozraste i kardial'naia patologiia. II Natsional'nyi Kongress «Kardionevrologiia». M., 2012. [in Russian]
8. Kamchatnov P.R. Vertebral'no-baziliarnaia nedostatochnost'. RMZh. 2004; 10: 614. [in Russian]
9. Nevrologiia. Natsional'noe rukovodstvo. Pod red. E.I.Guseva, A.N.Konovalova, A.B.Gekht. M.: GEOTAR-Media, 2014; s. 264–79. www.geotar.ru/lots/Q0124938.htm [in Russian]
10. Onishchenko E.F. Otkrytoe oval'noe okno i insul't v klinicheskoi praktike. SPb.: ELBI-SPb., 2005; s. 43. [in Russian]
11. Prekina V.I., Samol'kina O.G. Nadzheludochkovye i zheludochkovye aritmii serdtsa pri ishemicheskom insul'te. Sovr. problemy nauki i obrazovaniia. 2014; 4. [in Russian]
12. Skvortsova V.I., Stakhovskaia L.V., Prianikova N.A. i dr. Vtorichnaia profilaktika insul'ta – vzgliad nevrologa. Mezhdunar. nevrologicheskii zhurn. 2007; 2: 19–23. [in Russian]
13. Skvortsova V.I., Kol'tsova E.A., Kimel'fel'd E.I.. Ishemicheskii insul't u bol'nykh molodogo vozrasta. Zhurn. nevrologii i psikhiatrii im. S.S.Korsakova. Insul't. 2009; 109 (10): 3–14. [in Russian]
14. Cuslina Z.A., Petrova E.A., Foniakin A.V. i dr. Znachenie Kholterovskogo monitorirovaniia EKG u bol'nykh v ostrom periode ishemicheskogo insul'ta. Terapevt. arkhiv. 1997; 4: 24–6. [in Russian]
15. Suslina Z.A. Ishemicheskii insul't: sosudy, serdtse, krov'. Zhurn. nevrologii i psikhiatrii im. S.S.Korsakova. 2007; 5: 50–1. [in Russian]
16. Foniakin A.V., Geraskina L.A., Suslina Z.A. Sootnoshenie razmera tserebral'nogo ishemicheskogo ochaga i mesta formirovaniia embologennogo substrata pri kardioembolicheskom insul'te. Nevrologicheskii zhurn. 2003; 1: 10–3. [in Russian]
17. Shevchenko Iu.L., Odinak M.M., Kuznetsov A.N., Erofeev A.A. Kardiogennyi i angiogennyi tserebral'nyi ishemicheskii insul't. M.: GEOTAR-Media, 2006; s. 127–36. [in Russian]
18. Shkol'nikova M.A., Kharlap M.S., Il'darova R.A. Geneticheski determinirovannye narusheniia ritma serdtsa. Ros. kardiologicheskii zhurn. 2011; 1 (87). [in Russian]
19. Adams RJ, Albers G, Alberts MJ et al. American Heart Association American Stroke Association (2008) Update to the AHA/ASA recommendations for the prevention of stroke in patients with stroke and transient ischemic attack. Stroke 2008; 39: 1647–52.
20. Rautaharju PM, Surawic B, Gettes LS. AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram Part IV. J Am Coll Cardiol 2009.
21. Ankerman M. Cardiac causes of sudden unexpected death in children and their relationship to seizures and syncope: genetic testing for cardiac electropathies. Semin Pediatr Neurol 2005; 12: 52–8.
22. Antzelevitch C, Burashnikov A, Di Diego J. Mechanisms Cardiac Arrhythmia 2008; p. 65–133.
23. Bogousslavsky J, Regli F. Ischemic stroke in adults younger than 30 year of age. Ibid 1987; 44: 479–82.
24. Bogousslavsky J, van Melle G, Regli F. The Laussanne Stroke Registry: analysis of 1000 consecutive patients with first stroke. Stroke 1988; 19: 1083–92.
25. Botto N, Spadoni I, Giusti S et al. Prothrombotic mutations as risk factors for cryptogenic ischemic cerebrovascular events in young subjects with patent foramen ovale. Stroke 2007; 38 (7): 2070–3.
26. Caplan LR. Brain embolizm, revisited. Neurology 1993; 43: 1281–7.
27. Corbalon R, Tapia J, Braun S et al. Multidisciplinary study of cerebrovascular disorders. Cardiovascular profile of occlusive vascular disorders. Rev Med Chil 1994; 122 (9): 1021–30.
28. Deedwania P, Carbajal E. Silent ischemia during daily life is an independent predictor mortality in stable angina. Circulation 1990; 81.
29. Delcker A, Diener HC. Neurological diagnosis and therapeutic measures in cerebral emboliz. Herz 1991; 16: 434–43.
30. Engberding R, Stollberger C, Ong P et al. Isolated Non-Compaction Cardiomyopathy Dtsch Arztebl Int 2010; 107 (12): 206–13.
31. Flossman E, Schulz UG, Rothwell PM. Systematic review of methods and results of studies of the genetic epidemiology of ischemic stroke. Stroke 2004; 35: 212–27.
32. Adams HP, del Zoppo G, Alberts MJ et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association American Stroke Association Stroke Council. Stroke 2007; 38: 1655–711.
33. Hanna JP, Furlan AJ. Cardiac disease and embolic sources. Brain Ischemia: Basic Concepts and Clinical Relevance. Ed. L.R.Caplan. London, 1995; p. 299–315.
34. Hedley PL, Jorgensen P, Schlamowitz S et al. The genetic basis of long QT and short QT syndromes: a mutation update. Hum Mutation 2009; 30 (11): 1486–511.
35. Jousilahti P, Rastenyte D et al. Parental history of cardiovascular disease and risk of stroke. A prospective follow-up of 14371 middle-aged men and women in Finland. Stroke 1997; 28: 136–46.
36. Kim JA, Lopes CM, Moss AJ et al. Trigger-specific risk factors and response to therapy in long QT syndrome type 2. Heart Rhythm 2010; 7 (12): 1797–805.
37. Koennecke HC, Mast H, Trocio SS et al. Microemboli in patients with vertebrobasilar ischemia: association with vertebrobasilar and cardiac lesions. Stroke 1997; 28 (3): 593–6.
38. Lingren A, Roijer A, Rudling O et al. Cerebral lesions on magnetic resonance imaging, heart disease, and vascular risk factors in subjects without stroke – a population-based study. Stroke 1994; 25: 929–34.
39. Marcus H. Genes of stroke. J Neurol Neurosurg Psychiatry 2004; 75: 1229–31.
40. Mendel T, Jura E, Mizgalska J, Zambrovska A. Demonstration of cardiac arrhythmias in multi-infarct dementia and ischemic astroke using Holter monitoring. Neurol Neurochir Pol 1992; 26 (5): 605–11.
41. Meier B, Lock JE. Contemporary Management of Patent Foramen Ovale. Circulation 2003; 7 (14): 5–9.
42. Meschia JF. Clinically translated ischemic stroke genomics. Stroke 2004; 35 (Suppl. 1): 2735–9.
43. Messe SR, Silverman IE, Kizer JR et al. Practise parameter: recurrent stroke with patent foramen ovale and atrial septal aneurysm: report of the Quality Standarts Subcommittee of the American Academy of Neurology. Neurology 2004; 62 (7): 1042–50.
44. Mohr JP. Classification of strokes: Experience from Stroke Data Banks. Basel, 1994; p. 1–13.
45. Olshausen KV, Witt T. Sudden cardiac death while wearing a Holter monitoring. Am J Cardiol 1991; 67.
46. Overel JR, Bone I, Lees KR. Interatrial septal abnormalities and stroke: a meta-analysis of case-control studies. Neurology 2000; 55: 1172–9.
47. Page RL, Wilkinson WE, Clair WK et al. Asymptomatic arrhythmias in patients with symptomatic paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia. Circulation 1994; 89 (1): 224–7.
48. Priori SG, Antzelevitch C. Inherited arrhythmogenic diseases. In Sudden Cardiac Death. Ed. by S.G.Priori, D.P.Zipes. 2006.
49. Rothrock JF, Dittrich HC, Freck P et al. Mitral valve prolapse and ischemic stroke in the young. Circulation 1998; 78: 601.
50. Rubattu S, Gigante B, Stanzione R et al. In the search for stroke genes: a long and winding road. Am J Hypertens 2004; 17: 197–202.
51. Schimpf R, Wolpert C, Gaita F et al. Short QT syndrome. Cardiovasc Res 2005; 67: 357–64.
52. Stein JH, Soble JS. Thrombus associated with mitral valve calcification. A possible mechanism for embolic stroke. Stroke 1995; 26: 1697–9.
53. Streifler JI, Katz M. Cardiogenic cerebral emboli: diagnosis and treatment. Cur Opin Neurol 1995; 8: 45–54.
54. Winkle RA, Rodriguez J, Bragg-Remschel DA. Technological status and problems of ambulatory electrocardiographic monitoring. In: Clinical pharmacology of cardiac antiarrhythmic agents. New York, 1984; p. 108–16.
55. Yeung A, Barry I. Effects of asymptomatic ischemia of long-term prognosis in chronic stable coronary disease. Circulation 1991; 83.
56. Zipes DP, Jalife J. Cardiac electrophysiology. From cell to bedside. Elsevier. Fifth edition. 2009. Ventricular arrhythmias: mechanisms, features, and, management; p. 675–99, 723–79.
Авторы
Е.А.Петрова*, Е.А.Кольцова
ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1
*6332011@mail.ru
ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1
*6332011@mail.ru
________________________________________________
E.A.Petrova*, E.A.Koltsova
N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1
*6332011@mail.ru
N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1
*6332011@mail.ru
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