Heart problems after stroke

This review described the relationship between the brain and heart damage in stroke patients. They concluded that there are clinical indicators that could be helpful in diagnosing early stage heart problems in stroke patients.

Previous studies have shown that heart problems and failure are common in patients with cerebrovascular disease such as stroke or brain hemorrhage. It is therefore important to understand whether these heart problems are triggered by stroke, are an underlying cause of stroke or are an unrelated complication.

This review investigates the brain-heart interaction after stroke.

Stroke can lead to further cardiac damage which can be fatal and severe or mild and recoverable. Subarachnoid hemorrhage (SAH, bleeding into the space surrounding the brain) is associated with an increased risk of neurogenic stress cardiomyopathy (NSC, heart muscle weakness). Studies have shown that between 40 and 100% of SAH patients have NSC.

Ischemic stroke (IS, a blocked artery stops blood flow to the brain) can also lead to cardiac problems. These complications include vasospasm, where the heart muscle contracts and narrows blood vessels, reduced blood flow to the brain and excess fluid in the lungs. Cardiac arrhythmias (irregular heartbeat) are a common cause of death after IS.

Measuring the levels of a protein called cTn1 after stroke can act as a biomarker to detect cardiac damage. cTn1 levels are elevated in stroke patients with cardiac dysfunction.

Many stroke patients develop depression, including anxiety, fear and stress. The bodies’ response to this stress is an increased release of certain hormones including cortisol. In addition, the damage to the brain can lead to an increased release of the hormone catecholamine, which can be toxic to the cells in the heart. The increase release of hormones can result in a higher risk of cardiac arrhythmias and heart cell death. Furthermore, damage to the brain promotes the release of immune proteins that increase inflammation. This is associated with poor cardiac function and poorer recovery rates from heart disease.

Stroke can cause alterations to normal gut microbiota with a decrease in beneficial bacteria and an increase in gut permeability. Increased gut permeability can promote inflammation in the body and allows bacterial toxins travel to the blood stream. This can increase the risk of heart attack and heart failure.

The authors concluded that the relationship between the brain and heart in stroke patients demands focus and interventions are required to prevent post-stroke cardiac problems. They state that there are clinical indicators which could help to diagnose brain-heart disease at early stage.