HBS 2018, Chicago - The Connection Between Heart & Brain

The connection between Heart and Brain

The following text is an excerpt of an interview conducted with Prof. Natan Bornstein, Chairperson of the Heart and Brain Symposium. In it, he explains the significance of the connection between the heart and brain, and why the symposium will provide both neurologists and cardiologists with the fundamentals and updates in primary and secondary stroke prevention.

Explain the connection between the heart and the brain? Why is it important?

From the stroke point of view, 25% of all ischemic strokes are cardioembolic strokes, and the source of emboli and clots are formed in the heart, dislodged in the heart and then travel to the brain. Of the 25% of ischemic strokes, 45% of those are due to atrial fibrillation.

Among the cases of atrial fibrillation, proper treatment can reduce the risk of stroke by two-thirds. Unfortunately the awareness on one hand and the potential hazard of the treatment (drugs) on the other hand actually prevent three-quarters of eligible subjects from taking these medications.

New drugs in the field will minimize physicians' and patients' resistance to taking them, and we hope that this will be a breakthrough in the treatment of atrial fibrillation as a means to stroke prevention. Clots originating in the heart go to the brain, so the brain is the organ most affected by these emboli.

Looking at it from a different perspective, strokes occur in certain areas of the brain; these areas may affect the heart by causing arrhythmia - irregularities of the heart rate - and may cause sudden death. It's a two-way road. On one hand, the heart affects the brain. On the other hand, a stroke may also affect the patient's heart.

The basic concept behind this Symposium is the consolidation of all the needed information: the strokologist will teach the cardiologist about the brain and the neurologist will learn how the heart is affecting the brain. 

Why is the Heart and Brain Symposium unique?

There have been attempts in the past to hold heart and brain conferences, and there is some limited collaboration in research and academia. However, the Heart and Brain is the first meeting that tries to tackle the field from both sides. Previously neurologists talked among themselves. Now the idea is to involve more cardiologists and to have a crossroads, a dialogue.  We tend to live in separate departments, but there should be close collaboration between neurologists/strokologists and cardiologists - on a clinical basis.

What are the benefits to patients of this approach?

Our ultimate goal is to prevent strokes and especially recurring strokes. At the end of the day, if we discuss things openly in a multidisciplinary way, the patient will receive better treatment and management.  We know that we need to tackle both angles – neurology and cardiology. We don't have a joint clinic but eventually we will have a unit.

What are the "hot topics" in the field, which will be presented at the Symposium?

Atrial fibrillation is key, with the existing drugs and also new devices currently available on the market for stroke prevention. One of these is the appendage occluder which is placed near the source of the clot and prevents clots from reaching the brain. There are also new developments in endovascular treatment and devices which can seal the patent foramen ovali (hole between the atria). Because it is an important topic, there will be three plenary sessions on atrial fibrillation, including a comprehensive lecture on the new antidotes of the NOACS. There are also  new players to tackle dyslipidemia in heart & brain disease that will be discussed.

By the end of the Symposium, all participants will go home with vast and updated knowledge of this field. We will talk not only about research but also practical aspects. The cardiologists will have the knowledge to handle stroke patients and neurologists will understand how to treat their patients from a cardiology point of view.

Why should a cardiologist attend the Heart and Brain Symposium?

Stroke is an art and there is a lot of information which the cardiologist should know in terms of acute management and also stroke prevention. We'll have a special plenary session for the cardiologist.

Why should a neurologist attend the Heart and Brain Symposium?

The neurologist and internal medicine specialists will gain updated knowledge of how to treat cardioembollic strokes and will benefit from the knowledge about how the cardiologists treat pathological conditions of the heart which may affect the brain.