medigraphic.com
ISSN 1810-2352 (Impreso)

2012, Número 2

<< Anterior Siguiente >>

Rev Cub Med Int Emerg 2012; 11 (2)


Ictus isquémico y alteraciones electrocardiográficas

Sánchez LJV, Domínguez GL, Wong VL, Blanco VE, Chávez EJA, Ortega MLL

Idioma: Español
Referencias bibliográficas: 107
Paginas: 2408-2433
Archivo PDF: 201.26 Kb.


RESUMEN

Introducción: En pacientes con enfermedad cerebrovascular las complicaciones electrocardiográficas son clínicamente importantes porque representan para el paciente un pronóstico adverso.
Objetivo: Identificar las principales manifestaciones electrocardiográficas observadas durante la fase aguda de la enfermedad cerebrovascular isquémica.
Métodos: Se realizó un estudio retrospectivo descriptivo transversal, de serie de casos que incluyó a todos los pacientes con diagnóstico de ECV isquémica, ingresados en las unidades de cuidados neurointensivos del Instituto Nacional de Neurología y Neurocirugía y de la Unidad de Cuidados Especiales del Hospital Calixto García, desde Enero 2002 a Septiembre de 2011.
Resultados: El 58,5 % de los pacientes presentó complicaciones. El promedio de edad fue de 65 años. La mayor cantidad de casos con ictus isquémico se concentró en las edades entre 61 y 70 años, con un total de 73 casos para un 36,5 %, y en las edades entre 51 y 60 con un total de 47 pacientes para un 23,5 %. La alteración electrocardiográfica más frecuente resultó ser la taquicardia sinusal (52,5 %) seguido por las extrasístoles. La Onda T plana o invertida ocupó el tercer lugar (25,5 %).
Conclusiones: En la fase aguda del ictus isquémico, las complicaciones funcionales del cronotropismo cardiaco son más frecuentes que las alteraciones estructurales del miocardio. La etiología del ictus no influye sobre el riesgo de padecer alteraciones cardiovasculares durante su fase aguda. El sexo masculino y la existencia de enfermedad cardiaca previa constituyen factores de riesgo para la aparición de alteraciones cardiovasculares durante la fase aguda del ictus.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Topakian R, Nanz S, Rohrbacher B, Koppensteiner R, Aichner FT; OECROSS Study Group. High prevalence of peripheral arterial disease in patients with acute ischaemic stroke. Cerebrovasc Dis. 2010;29 (3):248-54.

  2. Thacker EL, Wiggins KL, Rice KM, Longstreth WT Jr, Bis JC, Dublin S, Smith NL, Heckbert SR, Psaty BM. Short-term and long-term risk of incident ischemic stroke after transient ischemic attack. Stroke. 2010;41(2):239-43.

  3. Hankey G.J., Slattery J.M., Warlow C.P. Transient ischaemic attacks. Which patients are at high (and low) risk of serius vascular events?. J Neurol Neruosurg psychiatry 1992; 55: 640-652.

  4. Nakajima M, Hirano T, Naritomi H, Minematsu K. Symptom progression or fluctuation in transient ischemic attack patients predicts subsequent stroke. Cerebrovasc Dis. 2010;29(3):221-7.

  5. Atkins ER, Brodie FG, Rafelt SE, Panerai RB, Robinson TG. Dynamic cerebral autoregulation is compromised acutely following mild ischaemic stroke but not transient ischaemic attack. Cerebrovasc Dis. 2010;29(3):228-35.

  6. Sanossian N, Saver JL, Kim D., Razinia T, Ovbiagele B. J. Stroke Cerebrovasc Dis. 2006; 15:187-189.

  7. Olsen TS, Chrstensen RH, Kammersgaard LP. Stroke. 2007; 38:2646-2651.

  8. Álvarez-Li FC. Epidemiologia de la Enfermedad Cerebrovascular en Cuba. Rev Neurol 1999; 29 (9): 868-871.

  9. Sáenz AJ, Porcel JM, Vives Soto M, Caballero MR. Epidemiología de la enfermedad Cerebrovascular aguda en la provincia de Lleida durante el período 1996-1997. Factores predictivos de mortalidad a corto y mediano plazo. Rev Neurol 1999; 28 (10): 941-948.

  10. Bots ML, Elwood PC, Nikitin Y, et al. J Epidemiol Community Health. 2002; 56 (suppl 1): i19–i24.

  11. Mellado, P.: Alteraciones cardiacas secundarias a enfermedades del sistema nervioso central en Cuadernos de Neurología. 1999. univ. Católica de Chile.

  12. Brawnwell, C: Can head injuries cause auricular fibrilation. Lancet/ 8, 1934.

  13. Beattie, J; Brow, G. R. y Long, C. N. H: Physiological and anatomical evidence for existente of nerve traces. Connecting the hypothalamus with espirial sympathetics centres, Proc –Roy; SOC. Series B. London 106: 253, 1930.

  14. Aschenbrenner, R y Bodechtel, G: Ueber EKG Veranderungen, veihrntumor kranken klin. Wochenschr. / 7: 298, 1938.

  15. Byer, E; Ashman, R; Toth, L. A.: Electrocardiogram with large upright. T waves and long Q-t intervals. Amheart J. 33: 796, 1947.

  16. Burch, E; Meyers, R; Abildskov. J: A new electrocardiographic observed in cerebrovascular accidents. Circulation 9: 719-723, 1954.

  17. Familoni OB, Odusan O, Ogun SA., The pattern and prognostic features of QT intervals and dispersion in patients with acute ischemic stroke.. J Natl Med Assoc. 2006 Nov;98(11):1758-62.

  18. Nighoghossian N, Cakmak S, Derex L, Barthelet M, Thibault H, Finet G, Ovize M, Derumeaux G, Nemoz C, Chapuis F, Rioufol G. Silent coronaropathy: usefulness of dobutamine stress echocardiography in ischemic stroke. Eur Neurol. 2006;56(4):211-6. Epub 2006 Oct 20.

  19. Fure B, Bruun Wyller T, Thommessen B. Electrocardiographic and troponin T changes in acute ischaemic stroke. J Intern Med. 2006 Jun;259 (6):592-7.

  20. Haft JI, Teichholz LE. Echocardiographic and clinical risk factors for atrial fibrillation in hypertensive patients with ischemic stroke. Am J Cardiol. 2008 Nov 15;102 (10):1348-51.

  21. Yoshimura S, Toyoda K, Ohara T, Nagasawa H, Ohtani N, Kuwashiro T, Naritomi H, Minematsu K. Takotsubo cardiomyopathy in acute ischemic stroke.. Ann Neurol.

  22. Catanzaro JN, Meraj PM, Zheng S, Bloom G, Roethel M, Makaryus AN. Electrocardiographic T-wave changes underlying acute cardiac and cerebral events. Am J Emerg Med. 2008 Jul;26(6):716-20.

  23. Yildiz A, Demirbag R, Yilmaz R, Gur M. ST-T changes in patients with acute ischemic stroke. Int J Cardiol. 2009 Apr 17; 133(3):397.

  24. Koskelo, P.; Ponsar, S y Sibila, W.: Subendocardial haemorrage and electrocardiograms changes in intracarneal bleeding. Brit Med. J. 1: 1479-1480, 1964.

  25. Burch, G. E.; Sun, S. C.; et al: Acute myocardial lesions following experimentally induced intracarneal haemorrage in mice. A histological and histochemical study. Arch. Path: 84. 517; 1967.

  26. Douen AG, Pageau N, Medic S. Serial electrocardiographic assessments significantly improve detection of atrial fibrillation 2.6-fold in patients with acute stroke. Stroke. 2008 Feb;39(2):480-2. Epub 2008 Jan 3.

  27. Patrignani A, Nannicosta MP, Antonini L, D'Aroma A, De Berardinis G, Cicogna S. [Myocardial and cerebral infarction as initial presentation of antiphospholipid syndrome] G Ital Cardiol (Rome). 2009 Apr;10(4):259-62.

  28. Hernández Meilan, O.: Alteraciones electrocardiográficas a ictus hemorrágicos, 1980, INNN. Trabajo para optar por el título de Especialista de 1er grado.

  29. Hernández Meilan, M: Alteraciones electrocardiográficas secundarias a ictus Isquémicos, 1980, INNN. Trabajo para optar por el título de especialista en 1er grado.

  30. Körtweig; G. C. J.; Boeles, J. T. F. y Tencate, J: Influence of stimulation of some subcortical areas o electrocardiogram. J. Neurophysiol. 20: 100-107, 1957.

  31. Weinberg, S. J. y Fuster, J. M: Hypothalamic control of Herat function as manisfested in electrocardiografics study. Arch int. Physiol, et. Biochim 67: 699, 1959.

  32. Weinberg, S. J y Fuster, J. M: Electrocardiographies changes, produced by localized hypothalamic simulations. Ann. Intern. Med. 53: 332-341, 1960.

  33. Porter, R. W; M. D. Kamikawa, K. M. D y Greenhoot, J. H: M.D. Persistent Electrocardiographic abnormalities experimentally induced by stimulation of the brain. Am Herat. J 64: 815-1819, 1962.

  34. Mauck, H. P. Jr. Y Hockman, C. H: Central Nervous Sisitem mechanism medianting cardiac rate and rhythm. Amer. Heart J. 74: 96-109, 1967.

  35. Jensen JK, Korsholm L, Høilund-Carlsen PF, Atar D, Kristensen SR, Mickley H. The relation between electrocardiographic ST-T changes and NT-proBNP in patients with acute ischemic stroke.. Scand Cardiovasc J. 2007 Oct;41(5):294-8.

  36. Jensen JK, Bak S, Flemming Høilund-Carlsen P, Mickley H. Prevalence of electrocardiographic ST-T changes during acute ischemic stroke in patients without known ischemic heart disease.. Int J Cardiol. 2008 Aug 1;128(1):137-8.

  37. Ninomiya T, Kubo M, Doi Y, Yonemoto K, Tanizaki Y, Rahman M, Arima H, Tsuryuya K, Iida M, Kiyohara Y. Impact of metabolic syndrome on the development of cardiovascular disease in a general Japanese population: the Hisayama study. Stroke. 2007 Jul;38(7):2063-9. Epub 2007 May 24.

  38. Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG. Classification of stroke subtypes. Cerebrovasc Dis. 2009; 27: 493-501.

  39. Adibhatla RM, Hatcher JF, Dempsey RJ. AAPS J. 2006, 8: E314-E21.

  40. Redón J, Cea-Calvo L, Lozano JV, Martí-Canales JC, Llisterri JL, Aznar J, González- Esteban J; Investigators of the PREV-ICTUS study. Blood pressure and estimated risk of stroke in the elderly population of Spain: the PREV-ICTUS study.. Stroke. 2007 Apr;38(4):1167-73. Epub 2007 Feb 22.

  41. Wagner GS, Hakacova N. Electrocardiographic measures of myocardial function and necrosis. JACC Cardiovasc Imaging. 2009 Oct;2(10):1195-7.

  42. Tovillas-Morán FJ, Zabaleta-del-Olmo E, Dalfó-Baqué A, Vilaplana-Cosculluela M, Galcerán JM, Coca A. Cardiovascular morbidity and mortality and left ventricular geometric patterns in hypertensive patients treated in primary care. Rev Esp Cardiol. 2009 Mar;62(3):246-54.

  43. Paciaroni M, Bogousslavsky J. Primary and Secondary Prevention of Ischemic Stroke. Eur Neurol. 2010 Mar 27; 63(5):267-278

  44. Mackintosh SF, Hill KD, Dodd KJ, Goldie PA, Culham EG. Balance score and a history of falls in hospital predict recurrent falls in the 6 months following stroke rehabilitation. Arch Phys Med Rehabil. 2006;(12):1583-9.

  45. Oppenheimer, S. M. and Hatchinsky, V. C: The cardiac consecuentes of stroke. Neurol. Clin. 10: 167, 1992.

  46. Ralea IC, Rioufol G, Cakmak S, Derex L, Nighoghossian N. Acute stroke and heart attack management within a four-hour time window. J Stroke Cerebrovasc Dis. 2009 Mar-Apr;18(2):167-70.

  47. Bedi M, Suffoletro M, Tanabe M, Gorcsan J, Saba S. Effect of concordance between sites of left ventricular pacing and dyssynchrony on acute electrocardiographic and echocardiographic parameters in patients with heart failure undergoing cardiac resynchronization therapy. Clin Cardiol. 2006 Nov;29(11):498-502.

  48. Coca A, Redón J, Cea-Calvo L, Lozano JV, Navarro J, Fernández-Pérez C, Bonet A, González-Esteban J; Investigators of the RIMH Study. Estimated risk of a first stroke and conditioning factors in Spanish hypertensive women. The RIMH study. Blood Press. 2006;15(4):237-44.

  49. Everett BM; Kurth T, Buring JE, et al. NJ Am Coll Cardiol 2006; 48: 2235 – 2242.

  50. Pasquini M, Laurent C, Kroumova M, Masse I, Deplanque D, Leclerc X, Bordet R, Leys D. Insular infarcts and electrocardiographic changes at admission: results of the PRognostic of Insular CErebral infarctS Study (PRINCESS). J Neurol. 2006 May;253 (5):618-24.

  51. Komrad, M. S; Coffey, C. E.; Coffey, K. S; et al: Myocardial for acute myocardial infarction and Stroke. Neurology. 34: 1403, 1984.

  52. Gillum, R. F.; Fortman, S. P: Internacional diagnostic criterial for acute myocardial infarction and acute stroke. Am heart J. 108: 15, 1997.

  53. Peurala SH, Airaksinen O, Huuskonen P, Jäkälä P, Juhakoski M, Sandell K,Tarkka IM, Sivenius J. Effects of intensive therapy using gait trainer or floor walking exercises early after stroke.J Rehabil Med. 2009 Feb; 41(3):166-73.

  54. Robinson RG, Spalletta G, Jorge RE, Bassi A, Colivicchi F, Ripa A,Caltagirone C. Decreased heart rate variability is associated with poststroke depression. Am J Geriatr Psychiatry. 2008 Nov;16 (11):867-73.

  55. Sanossian N, Sayer JL, Bazinia T, et al. Do high-density lipoprotein cholesterol levels influence stroke severity? J Stroke Cerebrovasc Dis. 2006; 15:187-189

  56. Olsen TS, Chrstensen RH, Kammersgaard LP. Stroke. 2007, 38:2646-2651.

  57. Ebrahim S, Sung J, Song YM, et al. BMJ. 2006; 333:22-27.

  58. Kurth MD, Everett B; Buring JE, et al. Neurology 2007, 68: 556 – 562.

  59. Everett BM; Kurth T, Buring JE, et al. NJ Am Coll Cardiol 2006, 48: 2235 – 2242.

  60. Byang O, Saver J, Liebeskinds D, et al. Neurology 2008, 70:841 – 847.

  61. Ois A, Gomis M, Cuadrado-Godia E, Jiménez-Conde J, Rodríguez-Campello A, Bruguera J, Molina L, Comin J, Roquer J. Heart failure in acute ischemic stroke. J Neurol. 2008 Mar;255(3):385-9.

  62. Hart RG, Bhatt DL, Hacke W, Fox KA, Hankey GJ, Berger PB, Hu T, Topol EJ; CHARISMA Investigators. Clopidogrel and aspirin versus aspirin alone for the prevention of stroke in patients with a history of atrial fibrillation: subgroup analysis of the CHARISMA randomized trial. Cerebrovasc Dis. 2008; 25(4):344-7.

  63. Chatterjee K, Rame JE. Systolic heart failure: chronic and acute syndromes. Crit Care Med. 2008 Jan;36(1 Suppl):S44-51.

  64. Ash-Bernal R, Peterson LR. The cardiometabolic syndrome and cardiovascular disease. J Cardiometab Syndr. 2006 Winter;1(1):25-8.

  65. Jahangir A, Lee V, Friedman PA, Trusty JM, Hodge DO, Kopecky SL, Packer DL, Hammill SC, Shen WK, Gersh BJ. Long-term progression and outcomes with aging in patients with lone atrial fibrillation: a 30-year follow-up study. Circulation. 2007 Jun 19;115(24):3050-6.

  66. Biyik I, Ergene O, Oto O. Late ventricular arrhythmias in patients with mechanical heart valves and their relation to associated factors. J Cardiovasc Surg (Torino). 2007 Feb;48(1):79-83.

  67. Gunalp M, Atalar E, Coskun F, Yilmaz A, Aksoyek S, Aksu NM, Sivri B. Holter monitoring for 24 hours in patients with thromboembolic stroke and sinus rhythm diagnosed in the emergency department. Adv Ther. 2006 Nov-Dec;23(6):854-60.

  68. Kuptniratsaikul V, Kovindha A, Suethanapornkul S, Manimmanakorn N, Archongka Y. Complications during the rehabilitation period in Thai patients with stroke: a multicenter prospective study.Am J Phys Med Rehabil. 2009 Feb; 88(2):92-9.

  69. Hua LP, Brown CA, Hains SJ, Godwin M, Parlow JL. Effects of low-intensity exercise conditioning on blood pressure, heart rate, and autonomic modulation of heart rate in men and women with hypertension. Biol Res Nurs. 2009 Oct;11(2):129-43.

  70. Ishimitsu T, Nakano N, Sudo Y, Akashiba A, Takahashi T, Ohta S, Minami J, Matsuoka H. Predictive significance of blood pressure values for the incidence of cardiovascular events in chronic hemodialysis patients. Hypertens Res. 2008 Sep;31(9):1703-9.

  71. Cygankiewicz I, Zareba W, de Luna AB. Prognostic value of Holter monitoring in congestive heart failure.. Cardiol J. 2008;15(4):313-23.

  72. Hyman DJ, Pavlik VN. N Engl J Med. 2001;345:479-486.

  73. Han MK, Huh Y, Lee SB, Park JH, Lee JJ, Choi EA, et al. Korean Consortium for Health and Aging Research. Prevalence of stroke and transient ischemic attack in Korean elders: findings from the Korean Longitudinal Study on Health and Aging (KLoSHA). Stroke. 2009; 40:966-9.

  74. Catanzaro JN, Meraj PM, Zheng S, Bloom G, Roethel M, Makaryus AN. Electrocardiographic T-wave changes underlying acute cardiac and cerebral events. Am J Emerg Med. 2008 Jul, 26 (6): 716-20.

  75. Tuomilehto J, Rastenyte D. J Cardiovascular Risk 1999; 6:241-249.

  76. Kalofoutis C, Piperi C, Kalofoutis A, Harris F, et al. Exp Clin Cardol. 2007; 12:17-28.

  77. Meeuwisse –Pasterkamp Sh, van der klauw MM, Wolffenbuttel Bil. Expert Rev Cardiovasc Ther. 2008, 6:323-341.

  78. Lawes CM, Vander Hoorn S, Rodgers A; Lancet 2008, 371:1513-1518.

  79. Binici Z, Intzilakis T, Nielsen OW, Køber L, Sajadieh A. Excessive supraventricular ectopic activity and increased risk of atrial fibrillation and stroke. Circulation. 2010 May 4;121(17):1904-11.

  80. Serena, J.; Segura, T.; Pérez Ayuso, M. J., et al: The need to quantify right to left shunt in acute ischemic stroke; 29: 1322-1328, 1998.

  81. Ko SB, Choi SI, Chun EJ, Ko Y, Park JH, Lee SJ, Lee J, Han MK, Bae HJ. Role of cardiac multidetector computed tomography in acute ischemic stroke: a preliminary report. Cerebrovasc Dis. 2010;29(4):313-20.

  82. Athyros VG, Kakafika AI, Tziomalos K, Papageorgio AA, Karagiannis A. Curr Vasc Pharmacol. 2008, 6; 124-133.

  83. Goldstein LB. Curr Atheroscler Rep. 2007; 9: 305-311.

  84. Henyan NN, Riche DM, East HE, Gann Pn, Ann Pharmacoter. 2007; 41: 1937-1945.

  85. Amarenco P, Bogousslavsky J, Callahan A, et al. N Engl J Med. 2006; 355:549-559.

  86. Ranga GS, Karla OP, Tandon H, Gambhir JK, Mehrotra G. J Stroke Cerebrovasc Dis. 2007 16: 220-224.

  87. Kunz A, Anrather J, Zhou P, Orio M, Iadecola C. J Cereb Blood Flow Metab. 2007; 27: 545-551.

  88. Oppenheimer, S. M; Wilson, J. X; Guiraudon, C et al: Insular cortex stimulation produces letal cardiac arrythmias. A mechanism of suddendeath? Brain. Res. 550: 115, 1991.

  89. Oppenheimer, S. M. and Cechetto, D. F: Cardiac. Chronotropic. Organization of the rat insular Cortex. Brain Res. 533. 66, 1990.

  90. Lazar J, Busch D, Wirkowski E, Clark LT, Salciccioli L. Changes in QT dispersion after thrombolysis for stroke. Int J Cardiol. 2008 Apr 10; 125(2):258-62.

  91. Platonov PG. Atrial conduction and atrial fibrillation: what can we learn from surface ECG? Cardiol J. 2008;15(5):402-7.

  92. Cygankiewicz I, Zareba W, de Luna AB. Prognostic value of Holter monitoring in congestive heart failure. Cardiol J. 2008;15(4):313-23.

  93. Fazelifar AF, Bonakdar HR, Alizadeh K, Azarnik H, Haghjoo M, Abkenar HB, Samiei N, Sadr-Ameli MA. Relationship between QRS complex notch and ventricular dyssynchrony in patients with heart failure and prolonged QRS duration. Cardiol J. 2008;15(4):351-6.

  94. Catanzaro JN, Meraj PM, Zheng S, Bloom G, Roethel M, Makaryus AN. Electrocardiographic T-wave changes underlying acute cardiac and cerebral events. Am J Emerg Med. 2008 Jul; 26(6):716-20.

  95. De Ruijter W, Assendelft WJ, Macfarlane PW, Westendorp RG, Gussekloo J. The additional value of routine electrocardiograms in cardiovascular risk management of older people. Scand J Prim Health Care. 2008;26(3):147-53.

  96. Kurl S, Laukkanen JA, Niskanen L, Laaksonen D; Sivenius J, et al. Stroke. 2006; 37: 806-811.

  97. Cecchi E, Liotta AA, Gori AM, Valente S, Giglioli C, Lazzeri C, Sofi F, Gensini GF, Abbate R, Mannini L. Relationship between blood viscosity and infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Int J Cardiol. 2009 May 15;134(2):189-94.

  98. Abhayaratna WP, Fatema K, Barnes ME, Seward JB, Gersh BJ, Bailey KR, Casaclang-Verzosa G, Tsang TS. Left atrial reservoir function as a potent marker for first atrial fibrillation or flutter in persons > or = 65 years of age. Am J Cardiol. 2008 Jun 1;101(11):1626-9.

  99. Yu EH, Lungu C, Kanner RM, Libman RB. The use of diagnostic tests in patients with acute ischemic stroke. J Stroke Cerebrovasc Dis. 2009 May-Jun;18(3):178-84.

  100. Iranmanesh F. Prognostic value of electrocardiography and electroencephalography in patients with ischemic stroke. Acta Neurol Taiwan. 2008 Dec;17(4):228-32.

  101. Lane, R. D.; Wallace, J. D.; Petrovsky, P. P; et al: Supraventricular tachycardia in patiens with right hemisfere strokes. Stroke 1996, Mar 23 (3) 362-6.

  102. Kollmar R, Schellinger PD, Steigleder T, Köhrmann M, Schwab S. Ice-cold saline for the induction of mild hypothermia in patients with acute ischemic stroke: a pilot study. Stroke. 2009 May;40(5):1907-9.

  103. Siccoli MM, Valko PO, Hermann DM, Bassetti CL. Central periodic breathing during sleep in 74 patients with acute ischemic stroke - neurogenic and cardiogenic factors. J Neurol. 2008 Nov;255(11):1687-92.

  104. Faber TS, Gradinger R, Treusch S, Morkel C, Brachmann J, Bode C, Zehender M; EVENTS Investigators. Incidence of ventricular tachyarrhythmias during permanent pacemaker therapy in low-risk patients results from the German multicentre EVENTS study. Eur Heart J. 2007 Sep;28(18):2238-42.

  105. Hocini M, Nault I, Wright M, Veenhuyzen G, Narayan SM, Jaïs P, Lim KT, Knecht S, Matsuo S, Forclaz A, Miyazaki S, Jadidi A, O'Neill MD, Sacher F, Clémenty J, Haïssaguerre M. Disparate evolution of right and left atrial rate during ablation of long-lasting persistent atrial fibrillation. J Am Coll Cardiol. 2010 Mar 9;55(10):1007-16.

  106. Cho HJ, Choi HY, Kim YD, Nam HS, Han SW, Ha JW, Chung NS, Heo JH. Transoesophageal echocardiography in patients with acute stroke with sinus rhythm and no cardiac disease history. J Neurol Neurosurg Psychiatry. 2010 Apr;81(4):412-5.

  107. Lau DH, Huynh LT, Chew DP, Astley CM, Soman A, Sanders P. Prognostic impact of types of atrial fibrillation in acute coronary syndromes. Am J Cardiol. 2009 Nov 15;104(10):1317-23.6




2020     |     www.medigraphic.com