Cerebrovascular incidents after myocardial infarction.

Pathological studies show a high correlation between the degree of atheroma in coronary, cerebral, and carotid arteries. Necropsy evidence of myocardial infarction also shows a high prevalence of severe atheroma in the carotid arteries. A further pathological finding is that obstruction in cerebral and carotid circulations is commonly due to embolism from the heart. In contrast, long-term follow-up of survivors of myocardial infarction indicates a low prevalence of cerebrovascular disease. To test if this low prevalence is due to lack of clinical ascertainment, a study was made of 260 survivors of myocardial infarction followed for five years. Specific attention was given to eliciting any clinical manifestations of cerebrovascular disease. In this study it was confirmed that in survivors of myocardial infarction the prevalence of cerebrovascular disease is surprisingly low: completed strokes 4%, transient cerebral ischaemic attacks 2%. A possible explanation of the low prevalence is that after the acute episode of myocardial infarction attacks of cardiac dysrhythmia predisposing to systemic embolism become infrequent.