The connection between the heart & the brain

​​​The following text is an excerpt of an interview conducted with Prof. Natan Bornstein, Co-Chairman of the International Conference on Heart and Brain. In it, he explains the significance of the connection between the heart and brain, and why the conference will provide both neurologists and cardiologists with groundbreaking insights into this developing field.

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 connected to the heart, 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 Conference is the consolidation of a hybrid field - neurocardiology or cardio-neurology: the strokologist will teach the cardiologist about the brain and the neurologist will learn how the heart is affecting the brain. For these reasons, there is a very strong connection in the stroke field between the heart and brain.

Why is the International Conference on Heart and Brain 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 International Conference on 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 vascular neurologists (strokologists), and cardiologists - on a clinical basis.

At my medical center (Tel Aviv Sourasky Medical Center - Ichilov), neurologists work closely with cardiologists, talking about particular pathologies which may affect the brain. We discuss clinical cases and how we manage them. This collaboration should not take place in conferences only, but on a regular basis, to form neurocardiology or cardio-neurology teams. Such an alliance would be fruitful for both fields.

What are the benefits to patients of this new 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 Conference?

Atrial fibrillation is key, with the new drugs existing 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 Conference, all participants will go home with vast and updated knowledge of this new 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 International Conference on Heart and Brain?

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 International Conference on Heart and Brain?

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.

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