The role of cardiologists on the stroke unit

Abstract

Cardiologists need a better understanding of stroke and of cardiac implications in modern stroke management. Stroke is a leading disease in terms of mortality and disability in our society. Up to half of ischaemic strokes are directly related to cardiac and large artery diseases and cardiovascular risk factors are involved in most other strokes. Moreover, in an acute stroke direct central brain signals and a consecutive autonomic/vegetative imbalance may account for severe and life-threatening cardiovascular complications. The strong cerebro-cardiac link in acute stroke has recently been addressed as the stroke-heart syndrome that requires careful cardiovascular monitoring and immediate therapeutic measures. The regular involvement of cardiologic expertise in daily work on a stroke unit is therefore of high importance and a cornerstone of up-to-date comprehensive stroke care concepts. The main targets of the cardiologists’ contribution to acute stroke care can be categorized in three main areas (i) diagnostics workup of stroke aetiology, (ii) treatment and prevention of complications, and (iii) secondary prevention and sub-acute workup of cardiovascular comorbidity. All three aspects are by themselves highly relevant to support optimal acute management and to improve the short-term and long-term outcomes of patients. In this article, an overview is provided on these main targets of cardiologists’ contribution to acute stroke management.

Impact of Cardiovascular Diseases on Ischemic Stroke Outcomes

“…Cardiovascular disease and large artery disease are responsible for up to half of the ischemic stroke cases. These cardiac diseases and risk factors are key risk factors to increase a patient's chance of recurrent strokes [9,15].…”

“…Cardiovascular disease and large artery disease are responsible for up to half of the ischemic stroke cases. These cardiac diseases and risk factors are key risk factors to increase a patient’s chance of recurrent strokes [ 9 , 15 ]. Cardiac pathologies increase a person’s risk for stroke, underscoring that cardiac diseases are key players in stroke.…”

“…Cardiac pathologies increase a person’s risk for stroke, underscoring that cardiac diseases are key players in stroke. The first sign of a patient experiencing a cardiac problem is usually caught during the workup following a stroke, suggesting a better diagnosis of cardiac disease is necessary to decrease the prevalence of stroke [ 9 ].…”

“…Following a stroke, a patient might experience a heart attack, cardiac arrest, or heart failure, leading to mortality [ 17 ]. Within 24–48 hours following a stroke, a person is at an increased risk for cardiac complications [ 9 ]. In addition to this timeframe where a person is susceptible to cardiac complications, cardiac causes of death are the second most common cause of death in acute stroke patients [ 18 ].…”

“…The purpose of this review is to focus on cardiovascular factors that influence stroke outcomes, as up to 50% of strokes are associated with cardiac and large artery diseases. In addition, cardiovascular risk factors are seen in other stroke etiologies and influence a patient’s outcome [ 9 ]. Including these factors in the development of future therapeutics should facilitate better translational success.…”