Stroke-associated damage to brain structure may lead to heart attack

Researchers using a new method of analyzing brain images have identified an area of the brain that, when affected by a stroke, may also cause damage to the heart muscle. The study, from the Martinos Center for Biomedical Imaging at Massachusetts General Hospital (MGH), finds that stroke patients with damage to the right insula, an area deep within the brain, were much more likely also to have biochemical evidence of myocardial damage occurring in the days following their stroke. Their report will appear in the May 9 issue of the journal Neurology and has received early online release.

"The link between the brain and the heart in stroke patients is fascinating. For instance, most patients with acute stroke have elevated blood pressure that returns to baseline over three to seven days. The connection is believed to be through the autonomic nervous system, but what the mechanism is has been unclear," says A. Gregory Sorensen, MD, of the Martinos Center, the paper's senior author. "By finding a specific brain area associated with a dramatically increased risk of heart damage, we can identify at-risk patients when they arrive at the hospital and put them on protective therapy, which should have a direct impact on their care."

About 5 percent of stroke patients will also have a heart attack damage to their heart muscle soon after the initial stroke. While many of these patients have generalized cardiovascular disease that can cause blockage to arteries supplying either the brain or the heart, some have no known previous vascular disease. One theory has been that the damaged brain sends signals through the autonomic nervous system which controls heart rate, blood pressure, digestion and other involuntary activities that stress the heart.

"Some patients can develop what looks like terrible heart failure during the weeks after their stroke," says Walter Koroshetz, MD, director of the MGH Stroke and Neurointensive Care Service, a co-author

Contact: Sue McGreevey
Massachusetts General Hospital

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