Neurology of Cardiovascular Disease

Sung-Min Cho, DO, MHS

Romergryko G. Geocadin, MD, FNCS, FAAN, FANA

Cardiovascular diseases, disorders of heart and blood vessels, are the leading cause of morbidity and mortality worldwide. Innovative and new medical therapy, devices, and procedures are being developed constantly in the field of cardiovascular disease. As neurologists, it is a common knowledge that cardiovascular diseases are intimately linked to neurological issues, either as a cause or a consequence. As advances in therapeutics and management strategy including mechanical circulatory support devices may have improved outcome in the field of cardiovascular medicine, improving neurological adverse events such as stroke and cognitive impairment is of the utmost importance in patients with cardiovascular disease. Therefore, it is important that “neurology-trained” physicians are up to date on these new developments and how they are related to neurological issues to provide appropriate neurological care for our patients.

In this issue of Seminars in Neurology, our goal is to provide a comprehensive review of the most recent advances and evidence on “Neurology of Cardiovascular Diseases.” We are especially interested in a close interaction between the heart and the brain and highlight the neurological effects and complications of cardiovascular diseases and its therapies. This issue of Seminars in Neurology provides authoritative reviews from neurologists who are directly engaged in this particular topic. The reviews on evidence of neurological care of common cardiovascular diseases include myocardial infarction, heart failure, atrial fibrillation, infective endocarditis, and cardiac arrest. In addition, the issue uniquely provides a comprehensive review on neurological issues and outcomes of patients who have undergone cardiac disease interventions such as left ventricular assist device (LVAD), extracorporeal membrane oxygenation (ECMO), and heart transplant. We are pleased that we were able to invite these experts of the field and the authors provided the best available evidence as well as their expert opinions and recommendations on neurological management of these patients with complex disease processes.

The issue begins with an outstanding article on discussing the challenges in managing concurrent acute ischemic stroke and acute myocardial infarction by Drs. Boyanpally, Cutting, and Furie. They provide a step-by-step management approach for this challenging clinical situation, which is an excellent review for both cardiologists and neurologists. Drs. Seol and Kim contribute an outstanding review of prevalence, mechanisms, and management of ischemic stroke in patients with heart failure. Their discussion on mechanisms of stroke in heart failure is informative. Drs. Migdady, Russman, and Buletko provide the most recent data on atrial fibrillation and ischemic stroke in a concise manner. This article is followed by an impressive review of antithrombotic therapy for stroke patients with cardiovascular disease, written by Drs. Gusdon, Farrokh, and Grotta, which is a huge undertaking given a plethora of information on this topic. Drs. Mayasi and Geocadin bring their expertise to provide updates on the management of neurological complications after cardiac arrest, highlighting upcoming clinical trials and future directions in the cardiac arrest field.

After these five articles on neurologic complications of cardiology-focused diseases in the first half of the issue, we shift our discussion on cardiovascular surgical patients in the latter half. Drs. Wang and Selim provide an excellent, concise review on neurological complications in patients with cardiac procedures and surgeries. Drs. Cho, Tahsili Fahadan, Kilic, Choi, Starling, and Uchino contribute a succinct review article on risk factors and mechanisms, and uniquely provide a multidisciplinary (neurology, cardiology, and cardiac surgery) recommendation on the management of LVAD-associated stroke. This is followed by Drs. Chiarini, Cho, Whitman, Rasulo, Lorusso's international collaboration and review on a multidisciplinary approach in managing acute brain injury in patients with ECMO support. Drs. Rice, Kovi, and Wisco provide an outstanding review on cerebrovascular complication and the timing of valve surgery in infective endocarditis based on their neurological expertise, as their center has the largest surgical volume of infective endocarditis. Finally, Drs. Sakusic and Rabinstein provide a distinctive review on neurological complications of heart transplant, which has not been discussed well in the literature. Particularly, their review on central nervous system infection in the setting of immunosuppression is an important review for clinicians.

We close our issue with two important articles. Drs. Breit, Bleck, and Koffman discuss a very important topic of delirium in patients with cardiovascular diseases in cardiac and cardiovascular surgical intensive care units. Finally, Drs. Johanson and Gottesman provide an excellent article on silent brain infarcts and cognitive outcome in patients with cardiovascular diseases. These two articles highlight the importance of subclinical and clinical brain injury/infarct and their impact on delirium and long-term cognitive outcome.

We greatly appreciate the expertise and dedication of our distinguished authors to this issue of “Neurology of Cardiovascular Diseases” in Seminars in Neurology. We sincerely thank all of our authors on their time and effort. We would like to express our sincere gratitude to Dr. David Greer, the editor-in-chief of Seminars in Neurology, for his guidance and insightful comments in each article. We also thank Dr. Ariane Lewis, the deputy editor of Seminars in Neurology, for her thoughtful input on the issue. We trust that readers will find this issue with most recent evidence and practical recommendations that will assist clinicians of different training backgrounds to provide better neurological care for patients with cardiovascular diseases. While this issue has provided cutting edge information, it has also captured in-depth knowledge as well as clinical practice gaps. It is our hope that these review articles will inspire further research and encourage to advance our practice on the “Neurology of Cardiovascular Diseases.” Certainly, after reviewing these exceptional articles as guest editors, we were reminded of Dr. William Osler's quote on intellectual humility, medical knowledge, and clinical experience. Perhaps, Osler's quote is many times truer today than it was a century ago and we believe our issue is providing a practical knowledge that is necessary in improving patient care.

The study of the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all. – Dr. William Osler.

In closing, we acknowledge that we will always be students in medicine and in life. We are grateful and dedicate this work to our patients, our mentors, and our families. To all our patients, who taught us the true essence of medicine; to our mentors (Dr. Cho: Dr. Romergryko Geocadin, Dr. Ken Uchino, Dr. Randall Starling, Dr. Nitish Thakor, Dr. Wendy Ziai, Dr. Jose Suarez, and Dr. Glenn Whitman; Dr. Geocadin: Dr. Joven R. Cuanang, Dr. Nitish Thakor, Dr. Dan Hanley, and Dr. Justin McArthur) who taught us that learning is never ending; and to our families (Dr. Cho: Sunyoung, Jeannie, and Yunee; Dr. Geocadin: Effie, Ginno, and Sofia) who taught us that love and support is essential as we keep moving in our quest for knowledge.

Publication History

Article published online:
19 August 2021