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136 Cardio Diabetes Medicine 2017

Effect of Stroke on Heart,

Diabetes & Hypertension

Prof. Dr. Lakshminarasimhan Ranganathan,
MBBS MD(Int. Med)., DNB (Int.Med) DM (Neuro)., DNB(Neuro)., Director and Professor,
Institute of Neurology Madras Medical College, Chennai

Dr. Lenin Sankar P, Dr.Thamil pavai N & Dr. Guhan R

Abstract:
Stroke is the second most common cause of death.
The most common diseases associated in the patho-
physiology of stroke are diabetes, hypertension, and
heart disease. Stroke in turn affects these diseas-
es adversely. Stroke can affect heart by producing
arrhythmias, left ventricular dysfunction, or isolated
cardiac enzyme elevation through myocytolysis. The
severity of cardiac involvement is proportional to the
neurological injury. Post–stroke hyperglycemia is a
commonly encountered entity, seen especially with
ischemic stroke and with involvement of insula in
specific. The post –stroke hyperglycemia is due to Figure 1. Relationship of Stroke With Heart, Diabetes
the action of inflammatory cytokines released from And Hypertension
the infarct which in turn increase glucose production The scope of this chapter is to highlight the ways
or decrease utilization. Impaired glucose tolerance by which stroke can affect heart, diabetes and hy-
and overt diabetes mellitus are also seen weeks af- pertension.
ter stroke onset in a significant number of patients.
Stroke results in acute hypertensive response com- Effects of stroke on heart: These are broadly
monly and hypotension rarely. The acute hyperten- classified into
sive response is stroke sub-type specific and it is 1. Electrical,
secondary to disturbed vasomotor tone. The central
key to the pathogenesis of stroke related effects on 2. Structural and
heart, diabetes and hypertension is disturbed auto- 3. Biochemical. (fig.2)
nomic function.
BRAIN
KEY WORDS: myocytolysis, neurogenic cardiac in-
jury, post-stroke hyperglycemia, acute hypertensive
response in stroke.
HEART
Introduction: Stroke is the second most common
cause of death worldwide and the first being isch-
emic heart disease. Both these vascular diseases
share most of the risk, diabetes and hypertension ELECTRICAL BIOCHEMICAL MECHANICAL
being the top two. Both hypertension and diabetes 1. BRADARRYTHMIAS 1. CARDIA 1. LV
ENZYME
have a definite role in deciding the outcome and 2. TACHYARRHYTHMIAS ELEVATION DYSFUNCTION
2. STRESS
morbidity associated with ischemic heart disease and 3. REPOLARISATION CARDIOMYOPATHY
ABNORMALITES
cerebrovascular disease. Heart and brain also affect
each other’s function in a vice-versa manner (fig.1). Figure2. EFFECTS OF STROKE ON HEART

GCDC 2017