UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Cardiac complications of stroke

Authors
Julio A Chalela, MD
Teresa L Jacobs, MD
Section Editor
Scott E Kasner, MD
Deputy Editor
John F Dashe, MD, PhD

INTRODUCTION

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 [1].

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 [2]. 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 [3]. The accumulation of risk was linear, suggesting that at 10 years after acute stroke, the risk of MI was approximately 20 percent.

              

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Mon Apr 11 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Kumar S, Selim MH, Caplan LR. Medical complications after stroke. Lancet Neurol 2010; 9:105.
  2. Prosser J, MacGregor L, Lees KR, et al. Predictors of early cardiac morbidity and mortality after ischemic stroke. Stroke 2007; 38:2295.
  3. Touzé E, Varenne O, Chatellier G, et al. Risk of myocardial infarction and vascular death after transient ischemic attack and ischemic stroke: a systematic review and meta-analysis. Stroke 2005; 36:2748.
  4. Amarenco P, Steg PG. Stroke is a coronary heart disease risk equivalent: implications for future clinical trials in secondary stroke prevention. Eur Heart J 2008; 29:1605.
  5. Chin PL, Kaminski J, Rout M. Myocardial infarction coincident with cerebrovascular accidents in the elderly. Age Ageing 1977; 6:29.
  6. Johnston KC, Li JY, Lyden PD, et al. Medical and neurological complications of ischemic stroke: experience from the RANTTAS trial. RANTTAS Investigators. Stroke 1998; 29:447.
  7. Yoshimura S, Toyoda K, Ohara T, et al. Takotsubo cardiomyopathy in acute ischemic stroke. Ann Neurol 2008; 64:547.
  8. Wong CK, White HD. Medical treatment for acute coronary syndromes. Curr Opin Cardiol 2000; 15:441.
  9. Jensen JK, Atar D, Mickley H. Mechanism of troponin elevations in patients with acute ischemic stroke. Am J Cardiol 2007; 99:867.
  10. James P, Ellis CJ, Whitlock RM, et al. Relation between troponin T concentration and mortality in patients presenting with an acute stroke: observational study. BMJ 2000; 320:1502.
  11. Mochmann HC, Scheitz JF, Petzold GC, et al. Coronary Angiographic Findings in Acute Ischemic Stroke Patients With Elevated Cardiac Troponin: The Troponin Elevation in Acute Ischemic Stroke (TRELAS) Study. Circulation 2016; 133:1264.
  12. Ay H, Arsava EM, Saribaş O. Creatine kinase-MB elevation after stroke is not cardiac in origin: comparison with troponin T levels. Stroke 2002; 33:286.
  13. Chalela JA, Ezzeddine MA, Davis L, Warach S. Myocardial injury in acute stroke: a troponin I study. Neurocrit Care 2004; 1:343.
  14. Hays A, Diringer MN. Elevated troponin levels are associated with higher mortality following intracerebral hemorrhage. Neurology 2006; 66:1330.
  15. Maramattom BV, Manno EM, Fulgham JR, et al. Clinical importance of cardiac troponin release and cardiac abnormalities in patients with supratentorial cerebral hemorrhages. Mayo Clin Proc 2006; 81:192.
  16. Goldstein DS. The electrocardiogram in stroke: relationship to pathophysiological type and comparison with prior tracings. Stroke 1979; 10:253.
  17. Chua HC, Sen S, Cosgriff RF, et al. Neurogenic ST depression in stroke. Clin Neurol Neurosurg 1999; 101:44.
  18. Samuels MA. The brain-heart connection. Circulation 2007; 116:77.
  19. Oppenheimer S, Norris JW. Cardiac manifestations of acute neurological lesions. In: Neurology and General Medicine, Aminoff MJ (Ed), Churchill-Livingstone, 1995. p.183.
  20. Parekh N, Venkatesh B, Cross D, et al. Cardiac troponin I predicts myocardial dysfunction in aneurysmal subarachnoid hemorrhage. J Am Coll Cardiol 2000; 36:1328.
  21. Jacob WA, Van Bogaert A, De Groodt-Lasseel MH. Myocardial ultrastructure and haemodynamic reactions during experimental subarachnoid haemorrhage. J Mol Cell Cardiol 1972; 4:287.
  22. Wang TD, Wu CC, Lee YT. Myocardial stunning after cerebral infarction. Int J Cardiol 1997; 58:308.
  23. Lane RD, Wallace JD, Petrosky PP, et al. Supraventricular tachycardia in patients with right hemisphere strokes. Stroke 1992; 23:362.
  24. Tokgözoglu SL, Batur MK, Topçuoglu MA, et al. Effects of stroke localization on cardiac autonomic balance and sudden death. Stroke 1999; 30:1307.
  25. Oppenheimer SM, Wilson JX, Guiraudon C, Cechetto DF. Insular cortex stimulation produces lethal cardiac arrhythmias: a mechanism of sudden death? Brain Res 1991; 550:115.
  26. Sander D, Klingelhöfer J. Changes of circadian blood pressure patterns after hemodynamic and thromboembolic brain infarction. Stroke 1994; 25:1730.
  27. Laowattana S, Zeger SL, Lima JA, et al. Left insular stroke is associated with adverse cardiac outcome. Neurology 2006; 66:477.
  28. Abboud H, Berroir S, Labreuche J, et al. Insular involvement in brain infarction increases risk for cardiac arrhythmia and death. Ann Neurol 2006; 59:691.
  29. Meyer S, Strittmatter M, Fischer C, et al. Lateralization in autonomic dysfunction in ischemic stroke involving the insular cortex. Neuroreport 2004; 15:357.
  30. Smith KE, Hachinski VC, Gibson CJ, Ciriello J. Changes in plasma catecholamine levels after insula damage in experimental stroke. Brain Res 1986; 375:182.
  31. Ruggiero DA, Mraovitch S, Granata AR, et al. A role of insular cortex in cardiovascular function. J Comp Neurol 1987; 257:189.
  32. Oppenheimer SM, Gelb A, Girvin JP, Hachinski VC. Cardiovascular effects of human insular cortex stimulation. Neurology 1992; 42:1727.
  33. Oppenheimer SM, Kedem G, Martin WM. Left-insular cortex lesions perturb cardiac autonomic tone in humans. Clin Auton Res 1996; 6:131.
  34. Zhang ZH, Rashba S, Oppenheimer SM. Insular cortex lesions alter baroreceptor sensitivity in the urethane-anesthetized rat. Brain Res 1998; 813:73.
  35. Sörös P, Hachinski V. Cardiovascular and neurological causes of sudden death after ischaemic stroke. Lancet Neurol 2012; 11:179.
  36. Ay H, Koroshetz WJ, Benner T, et al. Neuroanatomic correlates of stroke-related myocardial injury. Neurology 2006; 66:1325.
  37. Algra A, Gates PC, Fox AJ, et al. Side of brain infarction and long-term risk of sudden death in patients with symptomatic carotid disease. Stroke 2003; 34:2871.
  38. Hachinski VC. The clinical problem of brain and heart. Stroke 1993; 24:I1.
  39. Korpelainen JT, Sotaniemi KA, Huikuri HV, Myllylä VV. Circadian rhythm of heart rate variability is reversibly abolished in ischemic stroke. Stroke 1997; 28:2150.
  40. BYER E, ASHMAN R, TOTH LA. Electrocardiograms with large, upright T waves and long Q-T intervals. Am Heart J 1947; 33:796.
  41. Dimant J, Grob D. Electrocardiographic changes and myocardial damage in patients with acute cerebrovascular accidents. Stroke 1977; 8:448.
  42. Ramani A, Shetty U, Kundaje GN. Electrocardiographic abnormalities in cerebrovascular accidents. Angiology 1990; 41:681.
  43. Yamour BJ, Sridharan MR, Rice JF, Flowers NC. Electrocardiographic changes in cerebrovascular hemorrhage. Am Heart J 1980; 99:294.
  44. Di Pasquale G, Pinelli G, Andreoli A, et al. Holter detection of cardiac arrhythmias in intracranial subarachnoid hemorrhage. Am J Cardiol 1987; 59:596.
  45. Oppenheimer SM, Cechetto DF, Hachinski VC. Cerebrogenic cardiac arrhythmias. Cerebral electrocardiographic influences and their role in sudden death. Arch Neurol 1990; 47:513.
  46. Ibrahim GM, Macdonald RL. Electrocardiographic changes predict angiographic vasospasm after aneurysmal subarachnoid hemorrhage. Stroke 2012; 43:2102.
  47. Khechinashvili G, Asplund K. Electrocardiographic changes in patients with acute stroke: a systematic review. Cerebrovasc Dis 2002; 14:67.
  48. Hachinski VC, Oppenheimer SM, Wilson JX, et al. Asymmetry of sympathetic consequences of experimental stroke. Arch Neurol 1992; 49:697.
  49. Huang CH, Chen WJ, Chang WT, et al. QTc dispersion as a prognostic factor in intracerebral hemorrhage. Am J Emerg Med 2004; 22:141.
  50. Lavy S, Yaar I, Melamed E, Stern S. The effect of acute stroke on cardiac functions as observed in an intensive stroke care unit. Stroke 1974; 5:775.
  51. Vingerhoets F, Bogousslavsky J, Regli F, Van Melle G. Atrial fibrillation after acute stroke. Stroke 1993; 24:26.
  52. Valeriano J, Elson J. Electrocardiographic changes in central nervous system disease. Neurol Clin 1993; 11:257.
  53. Rem JA, Hachinski VC, Boughner DR, Barnett HJ. Value of cardiac monitoring and echocardiography in TIA and stroke patients. Stroke 1985; 16:950.
  54. Samuels MA. Electrocardiographic manifestations of neurologic disease. Semin Neurol 1984; 4:453.
  55. Kallmünzer B, Breuer L, Kahl N, et al. Serious cardiac arrhythmias after stroke: incidence, time course, and predictors--a systematic, prospective analysis. Stroke 2012; 43:2892.