Laura S.Boylan, Neurologist, New York University School of Medicine
Submitted March 28, 2018
It is notable that the only cardiac disease more prevalent in those with post-stroke atrial fibrillation (AF) than those in sinus rhythm was congestive heart failure. [1] Perhaps AF and congestive heart failure can be alternate expressions of an underlying shared susceptibility to neurocardiogenic problems.
Heart failure in the form of Takotsubo cardiomyopathy (TCM) (a.k.a. broken heart syndrome) is thought to be neurogenic. [2] TCM is typically stress induced, acute, and reversible. Stress may be psychological or physiologic. It is characterized by ballooning of the left ventricular apex, and absence of coronary artery disease. Neurologic and psychiatric conditions predispose. Classically, it occurs in post-menopausal women undergoing acute stress, such as learning of the death of a loved one. It is not rare in stroke, particularly subarachnoid hemorrhage. There are associated autonomic abnormalities. [3]
AF is commonly triggered by mental and physiologic stress. [4] Specific genetic predispositions to stress induced sudden cardiac death have been identified. [5] Neurogenic cardiac disease may be underappreciated; one estimate is that 1-2% of myocardial infarctions are neurogenic. [5] Understanding more about brain-heart connections may lead to novel interventions for neurologic and cardiovascular conditions. The 'autonomic' nervous system is not autonomous.
1. Sposato LA, Cerasuolo JO, Cipriano, et al. Atrial fibrillation detected after stroke is related to a low risk of ischemic stroke recurrence. Neurology 2018;90:e924-e931.
2. Templin C, Ghadri JR, Diekmann J, et al. Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy. N Engl J Med 2015;373:929-938.
3. Norcliffe-Kaufmann L, Kaufmann H, Martinez J, et al. Autonomic Findings in Takotsubo Cardiomyopathy. Am J Cardiol 2016;117:206-213.
4. Shusterman V, Lampert R. Role of Stress in Cardiac Arrhythmias. J Atr Fibrillation 2013;5:834.
5. Jeremy R. Neurogenic heart disease: from Voodoo to Tako-tsubo. Heart Lung Circ 2010;19:61-62.
For disclosures, please contact the editorial office at [email protected].
It is notable that the only cardiac disease more prevalent in those with post-stroke atrial fibrillation (AF) than those in sinus rhythm was congestive heart failure. [1] Perhaps AF and congestive heart failure can be alternate expressions of an underlying shared susceptibility to neurocardiogenic problems.
Heart failure in the form of Takotsubo cardiomyopathy (TCM) (a.k.a. broken heart syndrome) is thought to be neurogenic. [2] TCM is typically stress induced, acute, and reversible. Stress may be psychological or physiologic. It is characterized by ballooning of the left ventricular apex, and absence of coronary artery disease. Neurologic and psychiatric conditions predispose. Classically, it occurs in post-menopausal women undergoing acute stress, such as learning of the death of a loved one. It is not rare in stroke, particularly subarachnoid hemorrhage. There are associated autonomic abnormalities. [3]
AF is commonly triggered by mental and physiologic stress. [4] Specific genetic predispositions to stress induced sudden cardiac death have been identified. [5] Neurogenic cardiac disease may be underappreciated; one estimate is that 1-2% of myocardial infarctions are neurogenic. [5] Understanding more about brain-heart connections may lead to novel interventions for neurologic and cardiovascular conditions. The 'autonomic' nervous system is not autonomous.
1. Sposato LA, Cerasuolo JO, Cipriano, et al. Atrial fibrillation detected after stroke is related to a low risk of ischemic stroke recurrence. Neurology 2018;90:e924-e931.
2. Templin C, Ghadri JR, Diekmann J, et al. Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy. N Engl J Med 2015;373:929-938.
3. Norcliffe-Kaufmann L, Kaufmann H, Martinez J, et al. Autonomic Findings in Takotsubo Cardiomyopathy. Am J Cardiol 2016;117:206-213.
4. Shusterman V, Lampert R. Role of Stress in Cardiac Arrhythmias. J Atr Fibrillation 2013;5:834.
5. Jeremy R. Neurogenic heart disease: from Voodoo to Tako-tsubo. Heart Lung Circ 2010;19:61-62.
For disclosures, please contact the editorial office at [email protected].