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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 study
Setting: 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
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