My Authors
Read all threads
Ok Tweeples, we’re going on a #neurotwitter rapid review of tachy/bradyarrhythmias in strokes. A sprinkle of anatomy/physiology, a mini journal club, and chalk talk all wrapped up into one with a tweet to brain time <4.5min (don’t worry, we’ll spare the EVT 😉) 1/
Starting off. We’ve got our central autonomic network comprising of brainstem structures, as well as subcortical & cortical elements including the A&P insula, Inf & Med-F gyrus, Ant cingulate, vent-med prefrontal cortex, and amygdala. 2/
This is known as the heart-brain axis and is illustrated below: Image
The insula is important to this pathway. Early murine studies demonstrated laterality in cardiac regulation (right insula for sympathetic control and left insula for parasympathetic control). However, replication in human studies demonstrated mixed results. 4/
Here’s some insula neuroanatomy: pn.bmj.com/content/17/2/1… ImageImage
Functional mapping of autonomic cardiac responses to insular stimulation in epileptic patients revealed that right and left insular stimulation evoked tachycardia and bradycardia. Interestingly, tachycardias predominated in Posterior Insula and bradycardias in Median Insula 6/
These studies suggest parasympathetic control via R&L median insula and sympathetic control in R&L posterior insula. So we’ve seen these effects in epilepsy, and it is postulated to explain bradycardia and hypotension observed in some seizures. 7/
onlinelibrary.wiley.com/doi/full/10.10…
Is it seen in strokes though? Yes! Strokes involving the insula are commonly associated with bradycardia and 3rd degree AV blocks. Other strokes in this territory display a myriad of arrhythmias ranging from SVT to AF to VT/VF. 8/
A mild troponemia +/- EKG changes are observed commonly in strokes of both hemorrhagic and ischemic origins. While these changes have been associated with worsened mortality in stroke, it is important to rule out cardiac causes first. 9/
Great review article covering this #tweetorial with far more eloquence here: 10/ ahajournals.org/doi/full/10.11…
My first try at a @tony_breu style tweetorial. How'd I do?
@piripiribiryani (OBVIOUSLY she has nothing to do with this)
Missing some Tweet in this thread? You can try to force a refresh.

Keep Current with Phavalan Rajendram, MD

Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

Twitter may remove this content at anytime, convert it as a PDF, save and print for later use!

Try unrolling a thread yourself!

how to unroll video

1) Follow Thread Reader App on Twitter so you can easily mention us!

2) Go to a Twitter thread (series of Tweets by the same owner) and mention us with a keyword "unroll" @threadreaderapp unroll

You can practice here first or read more on our help page!

Follow Us on Twitter!

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3.00/month or $30.00/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!