Stroke as a complication of acute cardiac disease.

PURPOSE OF REVIEW

: Stroke is one of the most feared complications of acute cardiac disease and cardiac procedures. Cardiologists, cardiothoracic surgeons, and internal medicine physicians often request neurologic consultations for inpatients with active cardiac disease and for patients with planned cardiac procedures.

RECENT FINDINGS

: Neurologic consultations on cardiac inpatients are typically focused on two basic scenarios: (1) the risk of stroke and potential risk modifiers for patients in need of a particular cardiac procedure (eg, coronary artery bypass grafting [CABG]) or with a specific acute cardiac disease (eg, new atrial fibrillation or endocarditis); or (2) the evaluation of new neurologic deficits in periprocedural patients (eg, post-CABG) or those initially admitted with active cardiac disease (eg, worsening heart failure). Recent insights into these two scenarios are reviewed.

SUMMARY

: This article reviews a general approach to neurologic questions commonly encountered in the cardiac inpatient setting. Unique features and important recent insights are discussed. Less attention is given to the acute management of stroke in these patients (eg, contraindications for IV thrombolysis, options for endovascular therapy) or chronic stroke prevention strategies.