Likelihood of stroke arising from intermittent a-fib

[skywalker3]

Approximately two years ago I had a coronary artery bypass grafting times four and (2) cryoablation (pulmonary vein isolation).  My health had been very good post surgery until two weeks ago when I suffered a stroke which an MRI indicated was a acute infarct of 3.7cm in AP dimension x about 3.0 cm wide in the right parietal area.  I have been blessed with a quick recovery and have no residual effects from the stroke.  After the stroke I was placed on 75 mg. Plavix daily and continued with my previous daily medication regimen of 10 mg. Altace, 100 mg. Toprol XL, 20 mg. Zocor, and 2,000 mg. Niacain, and 4grams of fish oil.  My cholesterol two weeks ago was 127, with HDL of 31 and LDL of 69 and my blood pressure averages 125/75.  Both prior to and after the CABG and Maze procedure I have experienced PVC's but they have never felt like the lone A-Fib epidode I experienced prior to the CABG procedure. The echo ran after the stroke was normal and showed an ejection fraction of 70%.  I follow a really health lifestyle including vigorous cardio on a daily basis.  I follow a low-fat, low-salt, and low sugar diet.  I do not smoke and do not consume alcohol.  My most recent body fat calculation was 12%.  Due to my well controlled risk factors and the size and location of the brain infarct, my neurologist believes the stroke was caused by an emboli from the heart arising because of intermittent a-fib.  What treatment and testing protocol do you recommend to help discover the genesis of my stroke and prevent one in the future?  Do you think I should arrange an appointment with a specialist who deals with this type of problem and do you deal with this type of issue? This has been really frustrating because I have really been trying to control my risk factors.Many thanks your help on this matter!  With regards

[Michael J. McWilliams, M.D.]

I am sorry to hear about your stroke and am glad you are recovering well.  The risk of stroke with paroxysmal atrial fibrillation and persistent atrial fibrillation is equal.  The CHADS2 risk score is used to determine appropriateness of coumadin for atrial fibrillation patients for stroke risk reduction.  it stands for:
Congestive heart failure
Hypertension
Age greater than 75
Diabetes
Stroke.

If you have stroke, it is worth 2 points, the other risk factors are worth one.  If you have no contraindications to coumadin, 2 or more points means you should take coumadin (benefit is greater than the risk), 1 point means you can do either aspirin or coumadin, and 0 points aspirin is appropriate.  If you had a stroke and do not have contra indications, you should be on coumadin.  Plavix is not as good as coumadin for reducing the risk of atrial fibrillation induced or cardiac emboli.

I do treat a lot of atrial fibrillation.  Stroke risk prevention is a very important part of that.  It might be worth asking why Plavix was used instead of coumadin.

I hope this helps.