How the brain impacts the heart: lessons from ischaemic stroke and other neurological disorders

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.