Myocardial Infarction After Stroke

W. Perry Dickinson, MD

Disclosures

July 10, 2003

Question

What is the incidence of acute myocardial infarction as a complication of stroke?

Response from W. Perry Dickinson, MD

Approximately 9% of patients with acute cerebral infarction have a myocardial infarction (MI) at the same time or within a few days following this event.[1] The prognosis of patients with cerebral ischemia is strongly influenced by the common coexistence of coronary artery disease. MI or sudden death is the leading cause of death in patients with cerebrovascular disease.[2] More than 60% of deaths in patients who experience a transient ischemic attack result from an MI.[3]

Coronary angiography of a series of 506 patients with symptomatic carotid disease undergoing carotid endarterectomy revealed severe coronary artery disease in approximately 47% of patients suspected to have coronary artery disease and over 17% of those who were not.[4] This strong association of coronary artery disease with cerebrovascular disease has led some experts to recommend that all patients with carotid disease be evaluated for coronary artery disease.[5]

When a patient with underlying cardiovascular disease has a stroke, the resultant elevation in sympathetic nervous stimulation could potentially precipitate myocardial ischemia. With the evidence that cerebrovascular ischemia can cause cardiac arrhythmias and myocardial ischemia, it is also recommended that stroke patients should be monitored for cardiac arrhythmias and that cardiac enzymes should be obtained on patients with new ECG abnormalities.[6]

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