• Aso Sabir Shekhbzeni Department of Neurology, College of Medicine, University of Hawler, Erbil, Kurdistan Region, Iraq.




Schemic stroke, Arrhythmia, Autonomic function tests, Dysautonomia



Many studies have found that patients with ischemic stroke can develop autonomic system disturbances, affecting the heart, causing different types of arrhythmias and even sudden death. 


To analyze the occurrence of cardiovascular autonomic dysfunction and cardiac arrhythmias after acute ischemic stroke.

Patients and Methods

This case-controlled study was conducted at the Rizgary Teaching Hospital from July 1st, 2018, to September 30th, 2019. Fifty patients with acute ischemic stroke were enrolled consecutively and were age-matched and gender-matched with a group of 50 individuals (control group). Four bedside autonomic function tests (deep breathing, heart rate response to standing, isometric handgrip test, and blood pressure response to standing) were used to assess autonomic dysfunction during the acute post-stroke phase. In addition, all patients and controls underwent 24-hour Holter cardiac monitoring.


Although abnormal autonomic function testing was more frequent in post-stroke cases than in healthy controls, there was no statistically significant difference in these results among stroke sub-groups. There were more arrhythmias in patients with stroke in comparison with the control group; premature ventricular and atrial contractions were more frequent in stroke patients than in the control group (P-value <0.001 and P-value<0.001, respectively). 


Cardiac dysautonomia is common in patients with acute ischemic stroke, and cardiac dysrhythmias are commonly encountered in patients with insular infarctions. Whether these dysrhythmias are life-threatening or not, further analytic studies are required to uncover their clinical significance.


Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. heart disease and Stroke Statistics-2019 Update: A Report from the American Heart Association. Circulation. 2019;139(10): e56-e528.

Johnston SC, Mendis S, Mathers CD. Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling. Lancet Neurology. 2009;8(4):345-54. DOI: https://doi.org/10.1016/S1474-4422(09)70023-7

Bender M, Jusufovic E, Railic V, Kelava S, Tinjak S, Dzevdetbegovic D, et al. High Burden of Stroke Risk Factors in Developing Country: The Case Study of Bosnia-Herzegovina. Mater Sociomed. 2017;29(4):277-9. DOI: https://doi.org/10.5455/msm.2017.29.277-279

Dhamoon MS, Sciacca RR, Rundek T, Sacco RL, Elkind MS. Recurrent stroke and cardiac risks after first ischemic stroke: the Northern Manhattan Study. Neurology. 2006;66(5):641-6. DOI: https://doi.org/10.1212/01.wnl.0000201253.93811.f6

Jespersen CM, Hansen JF. Myocardial stress in patients with acute cerebrovascular events. Cardiology. 2008;110(2):123-8. DOI: https://doi.org/10.1159/000110491

Min J, Farooq MU, Greenberg E, Aloka F, Bhatt A. Cardiac dysfunction after left permanent cerebral focal ischemia: the brain and heart connection. Stroke. 2009;40(7):2560-3. DOI: https://doi.org/10.1161/STROKEAHA.108.536086

Barber M, Morton JJ, Macfarlane PW, Barlow N, Roditi G, Stott DJ. Elevated troponin levels are associated with sympathoadrenal activation in acute ischaemic stroke. Cerebrovasc Dis. 2006;23(4):260-6. DOI: https://doi.org/10.1159/000098325

Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J. 2088;155(3):408-17. DOI: https://doi.org/10.1016/j.ahj.2007.11.008

Kimmerly DS, O'Leary DD, Menon RS, Gati JS, Shoemaker JK. Cortical regions are associated with autonomic cardiovascular regulation during lower body negative pressure in humans. J Physiol. 2005;569(Pt 1):331-45. DOI: https://doi.org/10.1113/jphysiol.2005.091637

Amin OS, Shwani S. Hypocholesterolemia and hypertensive intracerebral haemorrhage: Any association? Gulhane Med J. 2018;60(4):125-9. DOI: https://doi.org/10.26657/gulhane.00036

Amin OSM. Bilateral internal carotid artery occlusion and recurrent ischemic stroke. BMJ Case Rep. 2015 June 8th;2015. PII: bcr2014207341. DOI: https://doi.org/10.1136/bcr-2014-207341

Amin OSM. Lacunar strokes: a single institutional experience. Cukurova Med J. 2013;38(4):659-66.

Lakusic N, Mahovic D, Babic T. Gradual recovery of impaired cardiac autonomic balance within first six months after ischemic cerebral stroke. Acta Neurol Belg. 2005;105(1):39-42.

Tatschl C, Stöllberger C, Matz K, Yilmaz N, Eckhardt R, Nowotny M, et al. Insular involvement is associated with QT prolongation: ECG abnormalities in patients with acute stroke. Cerebrovasc Dis. 2006;21(1-2):47-53. DOI: https://doi.org/10.1159/000089594

Lemieux F, Lanthier S,Chevrier MC, Gioia L,Rouleau I, Cereda C, et al. Insular Ischemic Stroke: Clinical Presentation and Outcome. Cerebrovasc Dis Extra. 2012;2(1):80-7. DOI: https://doi.org/10.1159/000343177

Kallmünzer B, Breuer L, Kahl N, Bobinger T, Raaz-Schrauder D, Huttner HB, et al. Serious Cardiac Arrhythmias After Stroke: Incidence, Time Course, and Predictors--A Systematic, Prospective Analysis. Stroke. 2012;43(11):2892-7. DOI: https://doi.org/10.1161/STROKEAHA.112.664318

European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee. Guidelines for the management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis. 2008;25(5):457-507. DOI: https://doi.org/10.1159/000131083

Adams HP , Alberts MJ, Grubb RL, Bhatt DL, Brass L, Jauch EC, et al. Guidelines for the early management of adults with ischemic stroke. Circulation. 2007;115(20):e478–e534. DOI: https://doi.org/10.1161/CIRCULATIONAHA.107.181486

Prosser J, MacGregor L, Lees KR, Diener HC, Hacke W, Davis S. Predictors of early cardiac morbidity and mortality after ischemic stroke. Stroke. 2007;38(8):2295-302. DOI: https://doi.org/10.1161/STROKEAHA.106.471813

Malik M. Heart Rate Variability: Standards of Measurement, Physiological Interpretation, and Clinical Use. Circulation. 1996;93(5):1043-65. DOI: https://doi.org/10.1161/01.CIR.93.5.1043

Kolominsky-Rabas PL, Weber M, Gefeller O, Neundoerfer B, Heuschmann PU. Epidemiology of Ischemic Stroke Subtypes According to TOAST Criteria: Incidence, Recurrence, and Long-Term Survival in Ischemic Stroke Subtypes: A Population-Based Study. Stroke. 2001;32(12):2735-40. DOI: https://doi.org/10.1161/hs1201.100209

Mawlood FJ.Prevalence of stroke in Hawler city; a household survey [dissertation]. Hawler: Hawler Medical College;2009.

Ohira T, Shahar E, Chambless LE, Rosamond WD, Mosley TH, Folsom AR. Risk Factors for Ischemic Stroke Subtypes. Stroke. 2006;37(10):2493-8. DOI: https://doi.org/10.1161/01.STR.0000239694.19359.88

Mahmood A, Sharif MA, Khan MN, Ali UZ. Comparison of Serum Lipid Profile in Ischaemic and Haemorrhagic Stroke. J Coll Physicians Surg Pak. 2010;20(5):317-20.

Korpelainen JT, Sotaniemi KA, Suominen K, Tolonen U, Myllylä V. Cardiovascular autonomic reflexes in brain infarction. Stroke. 1994;25(4):787-92. DOI: https://doi.org/10.1161/01.STR.25.4.787

Meyer S,Strittmatter M, Fischer C, Georg T, Schmitz B. Lateralization in autonomic dysfunction in ischemic. NeuroReport. 2004;15(2):357-61. DOI: https://doi.org/10.1097/00001756-200402090-00029



How to Cite

Shekhbzeni A. DYSAUTONOMIA FOLLOWING ACUTE ISCHEMIC STROKES: A SINGLE INSTITUTIONAL EXPERIENCE. JSMC [Internet]. 2022 Mar. 21 [cited 2024 Apr. 23];12(1):39-4. Available from: https://jsmc.univsul.edu.iq/index.php/jsmc/article/view/jsmc-10342

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