The Hidden Heart: Exploring Cardiac Damage Post-Stroke: A Narrative Review

Abstract

Stroke-heart syndrome (SHS), a critical yet underrecognized condition, encompasses a range of cardiac complications that arise following an ischemic stroke. This narrative review explores the pathophysiology, clinical manifestations, and implications of SHS, focusing on the complex interplay between the brain and the heart. Acute ischemic stroke (AIS) triggers autonomic dysfunction, leading to a surge in catecholamines and subsequent myocardial injury. Our review highlights the five cardinal manifestations of SHS: elevated cardiac troponin (cTn) levels, acute myocardial infarction, left ventricular dysfunction, arrhythmias, and sudden cardiac death. Despite the significant impact of these complications on patient outcomes, there is a notable absence of specific guidelines for their management. Through a comprehensive literature search, we synthesized findings from recent studies to elucidate the mechanisms underlying SHS and identified gaps in the current understanding. Our findings underscore the importance of early detection and multidisciplinary management of cardiac complications post-stroke. Future research should focus on establishing evidence-based protocols to improve clinical outcomes for stroke patients with SHS. Addressing this unmet need will enhance the care of stroke survivors and reduce mortality rates associated with cardiac complications.

Keywords: Takotsubo syndrome; autonomic dysfunction; brain; cardiac dysfunction; cardiac enzymes; catecholamine surge; myocardial dysfunction; neurogenic stress cardiomyopathy; neurogenic stunned myocardium; stroke; stroke–heart syndrome.

Figure 1

Pathophysiology of SHS [8,13]. Legend: this picture summarizes the mechanisms underlying SHS, offering a visual representation of the various factors that contribute to cardiac injury following a stroke.

Figure 2

Manifestations of SHS [8,10]. Legends: ECG—electrocardiogram; LVEF—left ventricular ejection fraction.