Treat the patient, not the disease: The embolic stroke of undetermined source as an opportunity to optimize cardiovascular prevention in a holistic approach.

IF 5.9 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL European Journal of Internal Medicine Pub Date : 2024-10-23 DOI:10.1016/j.ejim.2024.10.012
George Ntaios, Mayank Dalakoti
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Abstract

For any physician treating a patient with a medical condition of unclear etiology, the differential diagnosis aims to identify the actual most probable cause among various potential etiologies, in order to tailor treatment options. In patients with embolic stroke of undetermined source (ESUS), this can be challenging due to the frequent presence of multiple potential embolic sources, raising difficulties to identify the most likely cause. Additionally, despite targeted preventive measures for the presumed embolic source, patients may remain at risk for stroke and cardiovascular events due to other unrecognized or underestimated pathologies. The multi-level complexity and multimorbidity typically associated with ESUS, represents a challenge that requires broad knowledge of the cardiovascular pathophysiology, deep expertise of the available diagnostic and therapeutic options, and interdisciplinary approach. At the same time, it is an ideal opportunity to assess thoroughly the overall cardiovascular status of the patient, which in turn can allow us to optimize therapeutic and preventive strategies in a holistic approach, and prevent future strokes, cardiovascular events and disability through different parallel pathways. In this context, rather than narrowing our perspective on identifying the specific embolic source presumed to be the most likely cause of ESUS, it is crucial to shift our focus from the disease to the patient, and evaluate the overall cardiovascular profile by assessing the risk of all cardiovascular comorbidities present, no matter if causally associated with ESUS or not. In order to bring across these points and more, this article is centred around a clinical case that serves as a starting point to illustrate the holistic approach to the management of patients with ESUS. After all, this is the beauty, the magic and the art of Internal Medicine: to treat the patient, not the disease, the system or the organ.

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治疗病人,而不是治疗疾病:来源不明的栓塞性中风是以整体方法优化心血管预防的契机。
对于治疗病因不明的患者的任何医生来说,鉴别诊断的目的都是在各种潜在病因中找出最可能的实际病因,以便制定治疗方案。对于来源不明的栓塞性脑卒中(ESUS)患者来说,由于经常出现多种潜在的栓塞源,因此很难确定最可能的病因。此外,尽管对推测的栓塞源采取了有针对性的预防措施,但由于其他未被发现或低估的病变,患者仍有可能面临卒中和心血管事件的风险。ESUS 通常具有多层次的复杂性和多病症性,是一项挑战,需要广泛的心血管病理生理学知识、现有诊断和治疗方案的深厚专业知识以及跨学科方法。与此同时,这也是全面评估患者整体心血管状况的理想机会,反过来又能让我们以整体方法优化治疗和预防策略,并通过不同的并行途径预防未来的中风、心血管事件和残疾。在这种情况下,与其将视角局限于确定最有可能导致 ESUS 的特定栓塞源,不如将重点从疾病转移到患者身上,通过评估所有心血管合并症(无论是否与 ESUS 有因果关系)的风险来评估整体心血管状况。为了阐述这些观点和更多内容,本文将围绕一个临床病例展开,以此作为起点,说明对 ESUS 患者的整体管理方法。毕竟,这就是内科医学的魅力、神奇和艺术所在:治疗患者,而不是治疗疾病、系统或器官。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
European Journal of Internal Medicine
European Journal of Internal Medicine 医学-医学:内科
CiteScore
9.60
自引率
6.20%
发文量
364
审稿时长
20 days
期刊介绍: The European Journal of Internal Medicine serves as the official journal of the European Federation of Internal Medicine and is the primary scientific reference for European academic and non-academic internists. It is dedicated to advancing science and practice in internal medicine across Europe. The journal publishes original articles, editorials, reviews, internal medicine flashcards, and other relevant information in the field. Both translational medicine and clinical studies are emphasized. EJIM aspires to be a leading platform for excellent clinical studies, with a focus on enhancing the quality of healthcare in European hospitals.
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