Stroke heart problems
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Summary
10 papers analyzed
These studies suggest that stroke-heart syndrome involves cardiac complications triggered by stroke, shares common mechanisms, and is associated with poor short-term prognosis, while heart failure patients with a history of stroke are at high risk of cardiovascular events.
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Stroke and Heart Problems: Understanding the Interconnection
Introduction to Stroke-Heart Syndrome
Stroke-heart syndrome is a term used to describe the complex interplay between stroke and subsequent cardiac complications. This syndrome encompasses a range of cardiac issues that arise following an ischemic stroke, including myocardial injury, cardiac dysfunction, and arrhythmias . The underlying mechanisms involve stroke-induced alterations in the central autonomic network, leading to dysregulation of neural cardiac control, which can result in myocardial necrosis, microvascular dysfunction, and arrhythmogenesis.
Cardiac Complications Post-Stroke
Acute and Chronic Cardiac Events
Cardiovascular complications are common in the acute phase following a stroke, with severe adverse cardiac events occurring in 10% to 20% of patients within the first few days. These events range from acute myocardial injury and coronary syndromes to heart failure and arrhythmias. The majority of post-stroke deaths are attributed to neurological damage, but cardiovascular complications are the second leading cause of mortality.
Mechanisms of Cardiac Dysfunction
The pathophysiology of stroke-induced cardiac dysfunction involves several mechanisms, including autonomic dysfunction, systemic inflammation, and changes in cardiomyocyte metabolism . The hypothalamic-pituitary-adrenal axis, catecholamine surge, and sympathetic and parasympathetic regulation play significant roles in this interaction. Additionally, systemic mediators such as microvesicles, microRNAs, and the gut microbiome contribute to the cardiac changes observed after a stroke.
Heart Failure and Stroke
Prevalence and Outcomes
Heart failure (HF) patients, whether with reduced (HFrEF) or preserved ejection fraction (HFpEF), have a notable prevalence of stroke history, with 8.3% of HFrEF and 9.7% of HFpEF patients having experienced a stroke. These patients exhibit more vascular comorbidities and worse HF outcomes. The incidence of cardiovascular events, including stroke, is significantly higher in HF patients with a history of stroke compared to those without.
Risk Factors and Management
Patients with a history of stroke and HF are at a doubled risk of future strokes and other cardiovascular events. Despite this high risk, a significant proportion of these patients are not receiving guideline-recommended treatments such as anticoagulation for atrial fibrillation or statins for arterial disease. Addressing these gaps in treatment could improve outcomes for this high-risk population.
Quantifying Heart Disease Risk Post-Stroke
Prevalence of Coronary Artery Disease
Following an acute ischemic stroke (AIS), there is a high risk of coronary artery disease (CAD) and myocardial infarction (MI). Studies have shown that one-third of patients with AIS and no prior cardiac history have significant coronary stenosis, and 3% are at risk of developing MI within a year. This highlights the importance of screening for CAD in stroke patients to prevent subsequent cardiac events.
Diagnostic and Prognostic Tools
Blood biomarkers and electrocardiogram analyses are valuable tools for assessing the severity and prognosis of cardiac injury in stroke patients. These tools help distinguish whether cardiac abnormalities are due to coexisting ischemic heart disease or directly caused by brain injury, which is crucial for determining the appropriate treatment strategy.
Conclusion
The interconnection between stroke and heart problems is complex and multifaceted, involving a range of mechanisms and risk factors. Understanding stroke-heart syndrome and the associated cardiac complications is essential for improving patient outcomes. Addressing treatment gaps and utilizing diagnostic tools can help manage the high risk of cardiovascular events in stroke patients, ultimately leading to better long-term health outcomes.
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