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Brain and Heart Dynamics pp 1–16Cite as

Heart and Embolic Stroke of Undetermined Source

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Abstract

In 1947, Byer et al. first reported that cerebral vascular disease can cause myocardial damage and arrhythmia suggesting an interaction between heart and brain dynamics. Clinical and experimental evidence has accumulated since then, supporting the hypothesis that the brain can influence heart function and the heart can be responsible for secondary brain damage. It is crucial to determine whether heart dysfunction is triggered by stroke or vice-versa as this may influence the therapeutic strategy for secondary prevention. This is particularly true when dealing with those cryptogenic strokes whose clinical and neuroimaging characteristics suggest that their etiology is likely embolic, the so-called embolic stroke of undetermined source (ESUS). This chapter will explore the strengths and limitations of the ESUS definitions, its clinical and epidemiological aspects providing a description of patients who may fit this definition. The role of the possible sources of embolism in ESUS including arterial, minor-risk cardioembolic source such as structural abnormalities, subclinical atrial fibrillation, atrial high-rate episodes, and the influence of systemic inflammation are discussed as well. A brief review of the recent and ongoing clinical trial on this topic is also provided, highlighting the importance to validate standardized markers of atrial cardiopathy. These markers could improve the stratification of stroke recurrence risk and detect those patients with a cryptogenic stroke that are more likely to benefit from anticoagulant therapy.

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Authors and Affiliations

  1. Cerebrovascular Department, IRCCS Mondino Foundation, Pavia, Italy

    Anna Cavallini, Serena Magno, Alessandra Persico & Andrea Morotti

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  1. Anna Cavallini
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  2. Serena Magno
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  3. Alessandra Persico
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  4. Andrea Morotti
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Correspondence to Anna Cavallini .

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Editors and Affiliations

  1. Dept of Drug Sciences, Pharmacology Sect, University of Pavia, Dept of Drug Sciences, Pharmacology Sect, Pavia, Pavia, Italy

    Stefano Govoni

  2. Dept of Brain and Behavioural Sciences, University of Pavia Dept of Brain and Behavioural Sciences, Pavia, Pavia, Italy

    Pierluigi Politi

  3. Department of Molecular Medicine, University of Pavia, Department of Molecular Medicine, Pavia, Pavia, Italy

    Emilio Vanoli

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  1. IRCCS Mondino Foundation, Pavia, Italy

    Roberto Bergamaschi

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Cavallini, A., Magno, S., Persico, A., Morotti, A. (2019). Heart and Embolic Stroke of Undetermined Source. In: Govoni, S., Politi, P., Vanoli, E. (eds) Brain and Heart Dynamics. Springer, Cham. https://doi.org/10.1007/978-3-319-90305-7_35-1

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