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How the brain impacts the heart: lessons from ischaemic stroke and other neurological disorders
  1. Helena Stengl1,2,
  2. Wolfram C Poller3,
  3. Davide Di Vece4,5,
  4. Christian Templin4,6,7,
  5. Matthias Endres1,2,8,9,
  6. Christian H Nolte1,8,9,
  7. Jan F Scheitz1,8,9
  1. 1Department of Neurology with Experimental Neurology and Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
  2. 2German Center for Neurodegenerative Diseases, Partner Site Berlin, DZNE, Berlin, Germany
  3. 3Cardiology Division and Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
  4. 4Department of Internal Medicine B, Universitätsmedizin Greifswald, Greifswald, Germany
  5. 5First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
  6. 6Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland
  7. 7Swiss CardioVascularClinic, Private Hospital Bethanien, Zurich, Switzerland
  8. 8Berlin Institute of Health (BIH), Berlin, Germany
  9. 9German Centre for Cardiovascular Research, Partner Site Berlin, DZHK, Berlin, Germany
  1. Correspondence to Dr Jan F Scheitz; jan.scheitz{at}charite.de

Abstract

Cardiovascular alterations are common in patients who had ischaemic stroke, haemorrhagic stroke and other acute brain disorders such as seizures. These cardiac complications are important drivers of morbidity and mortality and comprise blood-based detection of cardiomyocyte damage, ECG changes, heart failure and arrhythmia. Recently, the concept of a distinct ‘stroke-heart syndrome’ has been formulated as a pathophysiological framework for poststroke cardiac complications. The concept considers cardiac sequelae after stroke to be the result of a stroke-induced disturbance of the brain–heart axis. In this review, we describe the spectrum of cardiac changes secondary to ischaemic stroke and other acute brain disorders. Furthermore, we focus on Takotsubo syndrome secondary to acute brain disorders as a model disease of disturbed brain–heart interaction. Finally, we aim to provide an overview of the anatomical and functional links between the brain and the heart, with emphasis on the autonomic network and the role of inflammation. Given the clinical relevance of the deleterious impact of acute brain injury on the heart, we call for clinical awareness and for starting joint efforts combining expertise of neurology and cardiology to identify specific therapeutic interventions.

  • Stroke
  • Cardiovascular Diseases
  • Arrhythmias, Cardiac
  • Inflammation
  • Biomarkers

https://doi.org/10.1136/heartjnl-2024-324173

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    Footnotes

    • X @Jan_FriSch

    • Contributors JFS, HS and CHN designed the outline of the review. All authors contributed to drafting the manuscript and made intellectual contributions to the text. JFS is the guarantor of this work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; externally peer reviewed.

    • Author note JFS is a participant in the Berlin Institute of Health-Charité Advanced Clinician Scientist Program, funded by the Charité - Universitätsmedizin Berlin and the Berlin Institute of Health. CHN is a Clinical Fellow of the Berlin Institute of Health.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.