Sunday, May 07, 2017

Cardiocerebral syndrome

This refers to cognitive dysfunction occurring in heart failure. It has been referred to in various ways through the years. I first blogged about it 11 years ago when it was called cardiac encephalopathy. It has since gained increasing recognition. Here are a few key points from a review and accompanying audio summary in JACC:

There are not only cognitive changes but also structural changes in the brain.

It can occur in both heart failure with reduced EF and heart failure with preserved EF.

It may be at least partially reversible with improvement in cardiac status.

Cerebral autoregulation may be impaired in heart failure.

Neurohumoral activation is contributory.

TNF and other cytokines are elevated and may contribute to cognitive dysfunction.

One third of hospitalized patients with heart failure have been reported to have thiamine deficiency! This may cause brain changes other than the classic Wernicke and Korsakoff syndromes.

Depression is common in heart failure.

What should the clinician do?

Diagnose it via the MMSE or some other clinical tool and exclusion of other causes.
Manage electrolyte problems.
Optimize heart failure management.
Identify and treat depression.
Give thiamine???

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