Anatomy and Cell Biology Publications
Title
Stroke-heart syndrome: clinical presentation and underlying mechanisms
Document Type
Review
Publication Date
12-2018
Issue
12
Journal
Lancet Neurology
Volume
17
First Page
1109
Last Page
1120
URL with Digital Object Identifier
https://doi.org/10.1016/S1474-4422(18)30336-3
Abstract
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.
