M STROKE-HEART SYNDROME

Stroke–Heart Syndrome: Clinical Presentation and Underlying Mechanisms

The Lancet Neurology

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• Cardiac complications are frequent in the setting of acute stroke. In this review, the authors label the collection of syndromes seen in this setting as stroke–heart syndrome, and provide a comprehensive overview. The proposed syndrome is described as evidence of acute myocardial injury, cardiac dysfunction, or cardiac arrhythmia following ischemic stroke, with an incidence of approximately 20%. The pathophysiology is complex, but much of the evidence points toward stroke-induced disturbances in the central autonomic networks, with an exaggerated stress response. The short-term prognosis is poor, but little is known about the potential long-term consequences.

• This is a useful reference for practitioners and trainees, and an opportunity to increase awareness of this potentially severe complication.

– Codrin I. Lungu, MD

Abstract

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Cardiac complications are a frequent medical problem during the first few days after an ischaemic stroke, and patients present with a broad range of symptoms including myocardial injury, cardiac dysfunction, and arrhythmia, with varying overlap between these three conditions. Evidence from clinical and neuroimaging studies and animal research suggests that these cardiac disturbances share the same underlying mechanisms. Although the exact cascade of events has yet to be elucidated, stroke-induced functional and structural alterations in the central autonomic network, with subsequent dysregulation of normal neural cardiac control, are the assumed pathophysiology. This dysregulation can promote myocardial necrosis, microvascular dysfunction, coronary demand ischaemia, and arrhythmogenesis. These stroke-associated cardiac alterations can be summarised as a distinct so-called stroke-heart syndrome. Independent cohort studies have shown a strong association between this syndrome and unfavourable short-term prognosis; however, long-term consequences, including secondary cardiac events and death, are less well described and specific therapeutic targets are scarce. An integrated view of stroke-heart syndrome will offer opportunities to expedite research and inform clinical decision making.