Atrial Fibrillation: An Underestimated Cause of Ischemic Monocular Visual Loss?
| Autor: | S. F. Cheng, Agnes Dados, Robert Simister, Angeliki Zarkali, Arvind Chandratheva |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Male
Time Factors Retinal Artery Occlusion medicine.medical_treatment Blindness Brain Ischemia Electrocardiography 0302 clinical medicine Recurrence Risk Factors Carotid artery disease Atrial Fibrillation London Prevalence Medicine Stroke Aged 80 and over biology Rehabilitation Atrial fibrillation Middle Aged Prognosis Echocardiography Ischemic Attack Transient Cardiology Female Cardiac monitoring Cardiology and Cardiovascular Medicine Adult medicine.medical_specialty Adolescent Amaurosis Fugax 03 medical and health sciences Young Adult Vision Monocular Diabetes mellitus Internal medicine ABCD2 Humans Aged Retrospective Studies business.industry medicine.disease biology.protein Surgery Neurology (clinical) Carotid imaging business 030217 neurology & neurosurgery |
| Zdroj: | Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 28(6) |
| ISSN: | 1532-8511 |
| Popis: | Introduction: Atrial fibrillation (AF) is a major cause of ischemic stroke and Transient Ischemic Attack (TIA) and investigation for paroxysmal AF is recommended following an embolic brain event. In contrast, retinal ischemic monocular blindness is traditionally considered most linked to carotid artery disease (CAS) and investigating for AF is less vigilant. We aimed to determine the prevalence of AF in patients with ischemic monocular blindness. Methods: Consecutive records of all patients presenting to a daily TIA clinic with transient or permanent ischemic monocular blindness were reviewed, January 2014-October 2016. Results: Of 400 patients, 224 (56.0%) were male, mean age 64.5 years (SD 15.1). A total of 263 (66%) presented with transient and 137 (34%) with permanent ischemic monocular blindness. ECG was performed in 364 patients (91%) but only 211 (52%) had further cardiac monitoring. The vast majority (97.3%) had carotid imaging. Thirty-six patients (9%) were found to have AF while 53 (14%) had ipsilateral CAS. Median ABCD2 score was 1 in AF and non-AF groups. Only 55% of known AF patients were anticoagulated at presentation, despite all having CHADVASC2 score greater than or equal to 1. Patients with AF had more hypertension (P = .004), previous TIA (P = .002), previous stroke (P = .044) and ischemic heart disease (P = .022) with no difference in age (P = .791), diabetes (P = .563), smoking (P = .460) nor hypercholesterolaemia (P = .083). Conclusions: A total of 9% of patients with ischemic monocular blindness had AF. This is an underestimate, as only 53% of patients had prolonged cardiac monitoring. Known AF was suboptimally managed with only 55% receiving anticoagulation despite being eligible. |
| Databáze: | OpenAIRE |
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