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Cardiac Complications After a Stroke

By Rosalyn Carson-DeWitt, MD

Updated November 08, 2008

(LifeWire) - The major consequences of a stroke are neurological changes, but cardiac problems may also complicate a stroke patient's recovery.

A study published in the journal Stroke looked at a group of 846 patients for 3 months after they had had a stroke. More than 1 in 3 had a serious cardiac event in that time, and over 4% died as a result. Although neurological damage is the most common cause of death after a stroke, cardiac complications rank second.

What Kinds of Cardiac Problems Commonly Occur After a Stroke?

In the days immediately following a stroke, heart attack, congestive heart failure, abnormal heart rhythms, and cardiac arrest are all much more likely to occur.

The abnormal heart rhythms known as "atrial fibrillation" and "atrial flutter" are particularly common. In both, the upper chambers of the heart -- the atria -- beat uncontrollably quickly and ineffectively.

If you suffer from atrial fibrillation, your heartbeat will be very erratic, or irregular. In contrast, if your atria "flutter," the rhythm of your heartbeat will be regular and very fast, yet ineffective. Both conditions are dangerous, as the upper chambers of the heart are pumping ineffectively, which means blood is not being systematically ejected from the heart out into the rest of the body.

Instead, blood pools in the atria, and blood clots may form. If clots move into the bloodstream, they may end up in the coronary arteries (where they could cause a heart attack) or the brain (where they could cause another stroke).

Read more about atrial fibrillation here.

Why Does Having a Stroke Increase a Person's Risk for Cardiac Trouble?

Some of the same risks that can lead to a stroke can also make heart problems more likely, including high blood pressure, diabetes, high cholesterol, coronary artery disease, and heart arrhythmias. Some of the chemical changes a stroke causes may affect the heart's functioning. For example, chemicals in the brain released into the bloodstream after a stroke may be bad for the heart.

A stroke can directly damage parts of the brain that control the heart. Right hemisphere damage (more than left) makes serious heart rhythm problems and death caused by the heart suddenly stopping much more likely.

What Can Be Done to Try to Prevent Cardiac Problems After Stroke?

Recent recommendations have suggested continually monitoring the heart of all hospitalized stroke victims for between 1 and 3 days to identify developing cardiac problems.

Here are some risk factors that may make it a particularly good idea to have continuous heart monitoring after a stroke:

  • Over 75 years old
  • Major rather than minor stroke. (A minor stroke is technically referred to as a transient ischemic attack, or TIA)
  • History of one or more of these:
    • Diabetes
    • Congestive heart failure
    • High blood pressure
    • Previous stroke
    • Ischemic heart disease (coronary artery disease)
  • High levels of serum creatinine, which is produced when muscle breaks down
  • High troponin I levels. Troponin is a protein found in heart muscle; it is released into the bloodstream when cells in the heart are injured or destroyed
  • High systolic blood pressure (the first, usually higher, number given in blood pressure results; it measures pressure when the heart is contracting)
  • Changes in the results of an electrocardiogram, which measures what's going on in your heart -- especially abnormal rhythm changes; early, extra beats of the ventricles of the heart; and atrial fibrillation and flutter as previously explained.


Chalela, Julio A, M. A. Ezzeddine, L. Davis, S. Warach. "Myocardial Injury in Acute Stroke." Neurocritical Care 1(2004): 343-346. http://www.ingentaconnect.com/content/hum/ncc/2004/00000001/00000003/art00008 (subscription).

Maramattom, Boby V. "Clinical Importance of Cardiac Troponin Release and Cardiac Abnormalities in Patients With Supratentorial Cerebral Hemorrhages." Mayo Clinic Proceedings 81(2006): 192-196. <http://www.mayoclinicproceedings.com/pdf%2F8102%2F8102a6.pdf>

Prosser, Jane, L. MacGregor, K. Lees, H.-C. Diene, W. Hacke, S. Davis. "Predictors of Early Cardiac Morbidity and Mortality After Ischemic Stroke." Stroke 38(2007): 2295. <http://stroke.ahajournals.org/cgi/content/full/38/8/2295>

LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Rosalyn Carson-DeWitt, MD, works as a medical writer, editor, and consultant in Durham, NC. She served as editor-in-chief for two multi-volume MacMillan encyclopedias: The Encyclopedia of Drugs, Alcohol, and Addictive Behavior and Drugs, Alcohol and Tobacco: Learning About Addictive Behavior. She worked on the 18th edition of the Merck Manual of Diagnosis and Therapy, and has written thousands of print and online articles for healthcare providers and consumers.

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