Chapter 6 - Neurological complications of coronary heart disease and their management

Abstract

While risk factors for the development of neurovascular and coronary heart disease (CHD) are similar, it is important to consider neurologic complications of CHD separately, as many of these complications are a direct result of the underlying condition or procedures performed to treat atherosclerotic coronary disease. Stroke after myocardial infarction (MI) and acute coronary syndromes (ACSs) is not infrequent, occurring in 0.7%-2.5% of patients within 6 months of the coronary event. The etiology of these events can be frequently traced to the development of left ventricular thrombus (LVT) formation after large MI episodes. Often, however, these events are directly related to catheter-based procedures or anticoagulation strategies utilized to treat the ACS. Ischemic strokes outnumber hemorrhagic strokes in this population. While there is a modest evidence base for use of anticoagulation to treat LVT, catheterization-related ischemic stroke and anticoagulation-related hemorrhagic stroke are typically managed via standard approaches.