Cardiac Complications After a Stroke

The major consequences of a stroke are neurological changes, but cardiac problems may also complicate a stroke patient's recovery.

Man talking to nurse, holding chest
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A study published in the journal Stroke looked at a group of 93,627 patients for one year after they suffered a stroke. The risk of having a major heart incident 30 days later was 25 times higher in women and 23 times higher in men. One year after stroke men and women were still twice as likely to have a major heart incident than peers who had not had a stroke. Although neurological damage is the most common cause of death after a stroke, cardiac complications rank second.

Common Cardiac Problems Following a Stroke

In the days immediately following a stroke, heart attack, congestive heart failure, abnormal heart rhythms, and cardiac arrest are all much more likely to occur.

The abnormal heart rhythms known as "atrial fibrillation" and "atrial flutter" are particularly common. In both, the upper chambers of the heart—the atria—beat uncontrollably quickly and ineffectively.

If you suffer from atrial fibrillation, your heartbeat will be very erratic, or irregular. In contrast, if your atria "flutter," the rhythm of your heartbeat will be regular and very fast, yet ineffective. Both conditions are dangerous, as the upper chambers of the heart are pumping ineffectively, which means blood is not being systematically ejected from the heart out into the rest of the body.

Instead, blood pools in the atria and blood clots may form. If clots move into the bloodstream, they may end up in the coronary arteries (where they could cause a heart attack) or the brain (where they could cause another stroke).

Having a Stroke Increases a Person's Risk for Cardiac Trouble

Some of the same risks that can lead to a stroke can also make heart problems more likely, including high blood pressure, diabetes, high cholesterol, coronary artery disease, and heart arrhythmias. Some of the chemical changes a stroke causes may affect the heart's functioning. For example, chemicals in the brain released into the bloodstream after a stroke may be bad for the heart.

A stroke can directly damage parts of the brain that control the heart. Right hemisphere damage (more than left) makes serious heart rhythm problems and death caused by the heart suddenly stopping much more likely.

Prevention of Cardiac Problems After Stroke

Recent recommendations have suggested continually monitoring the heart of all hospitalized stroke victims for between one and three days to identify developing cardiac problems.

Here are some risk factors that may make it a particularly good idea to have continuous heart monitoring after a stroke:

  • Over 75 years old
  • Major rather than minor stroke (A minor stroke is technically referred to as a transient ischemic attack, or TIA)
  • History of one or more of the following conditions: Diabetes, congestive heart failure, high blood pressure, previous stroke, or ischemic heart disease (coronary artery disease)
  • High levels of serum creatinine, which is produced when muscle breaks down
  • High troponin I levels. Troponin is a protein found in heart muscle; it is released into the bloodstream when cells in the heart are injured or destroyed.
  • High systolic blood pressure (the first, usually higher, number given in blood pressure results; it measures pressure when the heart is contracting).
  • Changes in the results of an electrocardiogram, which measures what's going on in your heart -- especially abnormal rhythm changes; early, extra beats of the ventricles of the heart; and atrial fibrillation and flutter as previously explained.
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  1. Sposato LA, Lam M, Allen B, Shariff SZ, Saposnik G. First-ever ischemic stroke and incident major adverse cardiovascular events in 93 627 older women and men. Stroke. 2020. doi:10.1161/STROKEAHA.119.028066

  2. Mitchell, LB. Atrial fibrillation and atrial flutter. Merck Manual Consumer Version. Kenilworth, NJ: Merck & Co., Inc.; 2019.

  3. Chen Z, Venkat P, Seyfried D, Chopp M, Yan T, Chen J. Brain-heart interaction: cardiac complications after stroke. Circ Res. 2017;121(4):451-468.