Table 1.

Summary of clinical manifestation of cardiac dysfunction following stroke in patients

	Subarachnoid hemorrhage (SAH)	Ischemic stroke (IS)	Comments
Takotsubo cardiomyopathy (TTC)	TTC is a transient left ventricular apical ballooning syndrome It is typically triggered by physical or emotional stress It is diagnosed by elevated cardiac enzymes, WMA, and ECG changes	Women are more prone to TTC and risk increases with age (IS in post menopausal stage)15	TTC is often misdiagnosed as acute coronary heart disease172 Patients are at risk for recurrence
Stress-induced cardiomyopathy	Dyspnea and chest pain, ECG abnormalities such as ST segment elevation, T wave inversion, prolonged QT interval and echocardiographic WMA172		Patients may also suffer from post stroke depression
	TTC-like LV dysfunction, delayed cerebral ischemia have been reported172	Early ECG abnormalities (few hrs −48 hours after IS onset)15 Infarcts in/near insular cortex15 Transient LV EF reduction15
Abnormal cardiac function and ECG abnormalities	Reduced ventricular EF Cardiac dysfunction increases with severity of stroke or hemorrhage 75% stroke patients have some ECG abnormality		High Troponin levels are related to the severity of reduced EF and LVDD173
	Cardiac arrhythmias during acute phase (~37.5% SAH patients) 18 WMA (15%-22% SAH patients)8 Hypokinetic WMA ECG ventricular repolarization disturbances such as ST elevation and T wave inversion that mimics acute myocardial infarction174	Cardiac arrhythmias (~22% IS patients) and LVDD (~50% IS patients)24 LVDD may or may not be symptomatic but both cases hinder functional recovery 18, 19 Severe LVDD (~10% IS patients) may indicate stroke with atrial fibrillation175 Impaired cardiac function after acute IS may predict a 3 month mortality176	Acute IS in right cerebral hemisphere increases susceptibility and severity of arrhythmias1 Patients have greater ECG abnormalities and are susceptible to developing supraventricular tachycardia177
Secondary Complications	Diastolic dysfunction correlated with pulmonary edema11, 176 Vasospasm with increased risk of delayed cerebral ischemia172	Severity of diastolic dysfunction increases composite vascular events at 1 year24
Recovery of Cardiac function	Corrected QT prolongation, bradycardia recovers immediately after aneurysmal clipping21 cTn I levels return to normal by Day 7178	LVH can persist at 7 days21 ST elevation/depression, T wave inversion persists at 7 days in some patients21 RWMA abnormalities tend to be temporary and improves in 66% patients at follow up179	LVDD persists in TTC when systolic function recovers at pre-discharge180 TTC after stroke maybe reversible24

Abbreviations: cTn: Cardiac Troponin; ECG: Electrocardiogram; EF: Ejection fraction; IS: Ischemic stroke; LV: Left ventricular; LVDD: Left ventricular diastolic dysfunction; LVEF: Left ventricular ejection fraction; LVH: Left ventricular hypertrophy; RWMA: Regional wall motion abnormalities; SAH: Subarachnoid hemorrhage; TTC: Takotsubo cardiomyopathy; WMA: Wall motion abnormalities.