Cardiac Complications and ECG Abnormalities After Stroke

Introduction

A significant overlap exists between cerebrovascular disease and cardiac disease. Cardiac disease is frequent in stroke patients, and cardiac abnormalities are also common following stroke. The most serious events include acute myocardial infarction (MI), heart failure, arrhythmias such as ventricular tachycardia, ventricular fibrillation, or atrial fibrillation, and cardiac arrest. Patients with cerebral atherosclerosis often have coronary artery disease (CAD) or peripheral vascular disease (PVD). Conversely, patients with CAD or PAD are at greater risk of stroke . A number of studies have demonstrated that patients with cerebrovascular disease are at significant risk for subsequent MI or vascular death in the years following a stroke, with cardiac disease as the most likely cause of death in stroke patients over time . In one inpatient acute stroke series, there was a cardiac cause of death in 35/846 patients (4%) with other serious cardiac adverse events in the first three months post stroke occurring in 161/84 patients (19%). Factors increasing the risk of serious cardiac events included severe clinical stroke, cardiac failure history, and renal dysfunction (creatinine > 1.3 mg/dl). ECG findings associated with increased risk included extra ventricular beats and prolonged QTc .

It is common for a cardiac cause of stroke to be identified only after the initial cerebrovascular event. It thus becomes critical to delineate whether those problems are secondary to stroke, coincidental, or the direct cause of the stroke.