Cardiac complications of stroke
- Julio A Chalela, MD
Julio A Chalela, MD
- Associate Professor of Neurology and Neurosurgery
- Medical University of South Carolina
- Teresa L Jacobs, MD
Teresa L Jacobs, MD
- Associate Clinical Professor of Neurosurgery and Neurology
- University of Michigan Hospitals and Health Center
Cardiac disturbances are common following stroke. To provide optimal care, it is essential to distinguish whether cardiopulmonary abnormalities are caused by the stroke, unrelated to it, or in the case of cardiac arrhythmias, the cause of the stroke. The distinction is often difficult because preexisting cardiac abnormalities are highly prevalent among stroke patients.
In this topic, we will review some of the major cardiac complications associated with stroke. Other medical complications of acute stroke are discussed separately. (See "Medical complications of stroke" and "Stroke-related pulmonary complications and abnormal respiratory patterns".)
CARDIAC MORBIDITY AND MORTALITY
Serious cardiac events and cardiac death after acute stroke may be caused by acute myocardial infarction, heart failure, ventricular arrhythmias such as ventricular tachycardia and ventricular fibrillation, and cardiac arrest .
●In a study involving 846 patients with acute ischemic stroke, cardiac death and serious cardiac adverse events in the first three months after stroke occurred in 35 and 161 patients (4 and 19 percent), respectively . Independent risk factors for serious cardiac adverse events were a history of heart failure, baseline creatinine >1.3 mg/dL (>115 micromol/L), severe stroke, and long QTc or ventricular extrasystoles on ECG.
●In a meta-analysis that included approximately 67,000 patients followed for a mean of 3.5 years after acute stroke, the annual risk of MI was about 2 percent . The accumulation of risk was linear, suggesting that at 10 years after acute stroke, the risk of MI was approximately 20 percent.
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- CARDIAC MORBIDITY AND MORTALITY
- MYOCARDIAL INFARCTION AND REGIONAL WALL MOTION ABNORMALITIES
- ELEVATED CARDIAC ENZYMES
- NEUROGENIC CARDIAC DAMAGE
- Insular stroke
- REPOLARIZATION AND ECG ABNORMALITIES
- QT prolongation
- T wave abnormalities
- ST segment alterations
- Q waves
- U waves