Heart Problems That Go Hand in Hand With Strokes

Heart problems are common in people who have a stroke. Heart disease is a stroke risk factor, and heart problems can develop or worsen during the acute phase of the stroke, during the recovery period—and afterward. If you've had a stroke, your healthcare team will closely monitor your heart condition and will also evaluate your heart health to ensure that you are getting the right treatment for any heart disease that you are diagnosed with.

Types of Cardiac Problems Seen With Stroke

Heart problems that are common among people who have had a stroke include myocardial infarction (heart attack), heart failure, and cardiac arrhythmias—especially atrial fibrillation, ventricular tachycardia, and ventricular fibrillation.

Heart problems associated with strokes may be caused by the same underlying process that produced the stroke, most commonly thrombosis (blockage) of an artery. Or, the heart problem may cause a stroke, such as when atrial fibrillation produces an embolus to the brain. Additionally, a stroke can precipitate a heart problem.

Stroke and Myocardial Infarction

As many as 13% of people who have had a stroke aged 60 or older will also have a heart attack within three days of the stroke. And a heart attack can be quickly followed by a stroke.

An acute stroke can make it difficult to perceive or communicate the symptoms of a heart attack, In the days after a stroke, you would be monitored carefully for signs of cardiac ischemia. This includes continuous ECG monitoring (cardiac telemetry) for the first few days and monitoring cardiac enzymes for signs of heart damage.

Link Between Stroke and Heart Attack

In many cases, stroke is caused by atherosclerosis, which is a narrowing and disease of the arteries that predisposes them to blockages. In the heart, coronary artery disease (CAD) leads to a heart attack.

Sometimes, a trigger—like severe infection or blood pressure changes—can cause a sudden blockage of atherosclerotic arteries, leading to both a heart attack and a stroke. And, in the immediate aftermath of a stroke or a heart attack, changes in blood pressure and other physical changes can lead to an acute blockage in other vessels that are already affected by atherosclerosis.

Treatment

Healthcare providers treating an acute heart attack will make sure that the patient is not also having a stroke before they use thrombolytic drugs (that is, “clot busters”). While dissolving a thrombosis in a coronary artery is often therapeutic, these treatments may lead to brain hemorrhage and a dramatic worsening of the stroke.

Most people who have survived a stroke or a heart attack need to take measures to reduce atherosclerotic disease. This includes medication and lifestyle modification.

Stroke and Heart Failure

Stroke can be associated with new or worsening heart failure. There are several reasons for this.

A stroke can trigger a dramatic increase in adrenaline levels and other hormones. These changes can lead to impaired function of the heart muscle, with cardiac ischemia (lack of oxygen in the heart muscle) even in people without CAD. The heart damage caused by this neurologically-mediated cardiac ischemia tends to be permanent and is common among young, healthy people who have a stroke due to subarachnoid hemorrhage.

Stroke is also associated with transient “cardiac stunning,” in which a portion of heart muscle suddenly stops working normally. This condition can produce episodes of severe, but temporary, heart failure.

Additionally, if a stroke is accompanied by myocardial infarction, heart failure can develop as a result.

Stroke and Cardiac Arrhythmias

An arrhythmia is an irregular heart rate or rhythm. An arrhythmia can cause a stroke, and a stroke can also worsen or cause arrhythmias. Significant cardiac arrhythmias are seen during the first few days in 25% of patients admitted to the hospital with acute stroke.

The arrhythmia most frequently associated with stroke is atrial fibrillation, which accounts for more than half of stroke-related heart rhythm problems.

Life-threatening arrhythmias may also occur, including ventricular fibrillation and cardiac arrest. In many cases, such potentially lethal arrhythmias are due to long QT syndrome, which may result from a stroke.

Significant bradycardia (slow heart rate) can also occur after a stroke. Usually, the bradycardia is transient, but occasionally significant heart block may be seen, requiring the insertion of a pacemaker.

Summary

Serious heart problems are common after a stroke. Anyone who's had a stroke needs to be carefully evaluated and monitored for at least several days for the possibility of myocardial infarction, heart failure, and cardiac arrhythmias. And having a stroke often indicates that you are at high risk for future cardiac problems, so post-stroke care involves measures to reduce the risk of a recurrent stroke, as well as reducing the risk of heart problems.