Restauration of sinus rhythm and embolism of regularization: a bidirectional relationship

Introduction: Embolism of regularization is an unpredictable event, which could occur even if proper anticoagulation is administrated. The most threatening location of the embolism is the brain and our paper was following a special case with this consequence. Methods: We present the case of a 84 year old patient, hospitalized for palpitations with recent onset (one week ago). Clinical examination revealed a systolic murmur on aorta focus and apex. Echocardiogram confirmed mild aortic stenosis and moderate mitral regurgitation; the initial electrocardiogram was with fast rate atrial flutter – 120 beats/minute. After 2.5 mg of Metoprolol the patient restored sinus rhythm, with severe sinusal bradycardia 35 beats/min. Enoxaparin 0.5 mg/kgc, twice daily, was given to our patient, before Metoprolol. We’ve suspected a tachy-bradycardia syndrome. Results: Three hours aft er sinus rhythm restauration, the patient developed vomiting, sweating, high blood pressure (190/80 mm Hg), aphasia and left upper limb paresis. The computed cerebral tomography confirmed an acute infarction of right cerebelous hemisphere and right cerebral peduncle. We’ve continued to administrate him enoxaparin and after 12 hours, the neurological signs were almost vanished, he could normally speak and move his left arm. Even if the patient developed a large cerebral infarction, he had a favorable clinical evolution. He promptly recovered the neurological status and he maintained an acceptable heart rate (50 beats/minute, sinusal bradycardia). Conclusions: This case advised us, once again, about the importance of team work and interdisciplinary approach of our patients; sinus rhythm restauration provoked cerebral embolism and neurological disorder leads to cardiac manifestations (bradycardia, arterial hypertension), through its particular location (cerebral peduncle).

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)