Cardiogenic Cerebral Embolism in Srinagarind Hospital

ABSTRACT

Background: Rheumatic heart disease is the most common valvular heart disease in Thailand and contributes to cerebrovascular disease.Objective:To study underlying diseases , recurrent rate and complication of anticoagulant therapy of cardiogenic cerebral embolism in Srinagarind Hospital.Design: Descriptive studySetting: Srinagarind Hospital, Faculty of Medicine, Khon Kaen University.Subjects: One hundred and eighty four patients who were diagnosed cardiogenic cerebral embolism in department of internal medicine service between 1985 and 1996.Measurement Underlying diseases, atrial fibrillation, long term follow up, recurrent rate and complication of anticoagulant therapy by percentage.Results: There were 184 cases, 81 males and 103 females. The patients’ mean age at diagnosis was 47.50 years (15-89 years). Underlying diseases were rheumatic heart disease (70.10%), non-valvular AF (9.23%), dilated cardiomyopathy (6.20%), bacterial endocarditis (3.80%) , ischemic heart disease (3.26%) , mitral valve prolapse ( 2.10%) , hyperthyroidism ( 2.10%) , prosthetic valve ( 1.63%) , hypertrophic cardiomyopathy ( 1.05%)  and ventricular septal defect with pulmonic stenosis ( 0.53%). Atrial  fibrillation was found in 124 cases ( 67.39%). Thirty nine patients (30.24%) were rheumatic heart disease without atrial fibrillation.  Recurrent rate within first year was 19.04%.  Intracerebral hemorrhage caused by anticoagulant therapy was 4.34%.Conclusion: Cardiogenic cerebral embolism was the most common cause of stroke in the young. Although the most common cause was rheumatic heart disease with atrial fibrillation but there were about 30% of rheumatic heart disease patients that still have normal sinus rhythm. Recurrent rate within one year was 19.04% while intracerebral hemorrhage caused by anticoagulant therapy was only 4.34%.Key words Cardiogenic cerebral embolism, rheumatic heart disease, atrial fibrillation