Emerging evidence indicates that 19% of ischemic stroke patients experience life-threatening cardiac events (acute myocardial infarction, ventricular tachycardia/fibrillation, or heart failure) within 3 months post-stroke , with arrhythmia incidence peaking at 25.1% during the critical 72-hour window post-event, predominantly manifesting as tachyarrhythmias associated with higher NIHSS scores and advanced age . Mechanistically, insular cortex lesions disrupt autonomic balance, elevating plasma catecholamines and potentiating myocardial injury , while diastolic blood pressure variability independently predicts stroke recurrence (aOR=1.53-1.60) and cardiovascular events (aOR=1.92-2.48). Despite guideline-recommended secondary prevention therapies, pharmacovigilance data reveal underappreciated cardiac risks: ticagrelor exhibits dose-dependent bradyarrhythmia induction, !-blockers/non-DHP CCBs may impair conduction, insulin-induced hypoglycemia triggers adrenergic arrhythmias, and lipid-lowering agents potentially exacerbate electrolyte imbalances, collectively highlighting an urgent need for systematic evaluation of iatrogenic cardiac risks in stroke survivors with inherent neurocardiac vulnerability.
