Can a stroke cause cardiac arrest?

[Lurker011]

there was a case at a hospital about 4 days ago when a 28 yr old male suffered a massive stroke. there was bleeding in the brain. he was put into a medically induced coma. the next day,he went into full asystolic arrest and after 20 minutes of CPR with no results,the doctor called off the code and patient was pronounced dead. could the stroke itself caused the heart to stop beating?

[vanburbian]

Yes, a stroke can be a result of or a cause of, cardiac arrest.

[xtxrn, ASN, RN]

Brain herniation, compressing the brainstem- lights out....

[Juwon]

Yes, it can, funny because I was just reading about this today and one of my medical books

[Corey Narry, MSN, RN, NP]

There's not much detail in this case to make a theoretical assumption regarding the physiology that led to the cardiac arrest.

We know that this patient had a stroke secondary to a bleed in the brain which in itself is a broad term because you didn't specify the location and type of the bleed. Knowing that piece of information will provide insight on what caused the bleed and what focal neuro deficits the patient would exhibit. You also said that the patient is in a medically-induced coma. The only few times a patient with a stroke will need to be placed on IV drip sedation (or medically-induced coma) is if they are having continuous seizures which could compromise the patency of the patient's airway. In that case, they would need to already be intubated and on a ventilator while the sedation is ongoing. Stroke patients who have neuro deficits severe enough that they are unconscious and unable to clear their airway are intubated and on a ventilator. In addition, there are respiratory centers in the brain that can control a patient's breathing (medulla and pons in the brainstem) and obviously any stroke that affects these structures could lead to absence of spontaneous breathing. But all that alludes to respiratory failure, not cardiac arrest.

You said the patient went into asystolic arrest the next day and was unsuccessfully resuscitated after 20 mins of CPR. The brain controls our breathing but the heart's activity is independent of the brain's control. A heartbeat is caused by activity within the heart's own electrical conduction system, thus, it makes me wonder whether this cardiac arrest is a separate entity from the patient's stroke. A few non-intrinsic cardiac conditions can cause absence of the heart's ability to conduct electrical impulses leading to asystole (hypoxia - i.e., patient could have had a mucus plug while intubated, hypovolemia - i.e., patient is massively bleeding internally or externally, acidosis - i.e., kidney failure, potassium derangements, etc). It could be possible that the patient had other causes of the cardiac arrest such as these non-intrinsic cardiac causes. Knowing that he is only 28, you can maybe invoke the possibility of an intrinsic cardiac event such as myocardial ischemia from an Acute MI. Even then, it's not a situation where the stroke actually caused the asystolic event or cardiac arrest.

[xtxrn, ASN, RN]

There's not much detail in this case to make a theoretical assumption regarding the physiology that led to the cardiac arrest.

We know that this patient had a stroke secondary to a bleed in the brain which in itself is a broad term because you didn't specify the location and type of the bleed. Knowing that piece of information will provide insight on what caused the bleed and what focal neuro deficits the patient would exhibit. You also said that the patient is in a medically-induced coma. The only few times a patient with a stroke will need to be placed on IV drip sedation (or medically-induced coma) is if they are having continuous seizures which could compromise the patency of the patient's airway. In that case, they would need to already be intubated and on a ventilator while the sedation is ongoing. Stroke patients who have neuro deficits severe enough that they are unconscious and unable to clear their airway are intubated and on a ventilator. In addition, there are respiratory centers in the brain that can control a patient's breathing (medulla and pons in the brainstem) and obviously any stroke that affects these structures could lead to absence of spontaneous breathing. But all that alludes to respiratory failure, not cardiac arrest.

You said the patient went into asystolic arrest the next day and was unsuccessfully resuscitated after 20 mins of CPR. The brain controls our breathing but the heart's activity is independent of the brain's control. A heartbeat is caused by activity within the heart's own electrical conduction system, thus, it makes me wonder whether this cardiac arrest is a separate entity from the patient's stroke. A few non-intrinsic cardiac conditions can cause absence of the heart's ability to conduct electrical impulses leading to asystole (hypoxia - i.e., patient could have had a mucus plug while intubated, hypovolemia - i.e., patient is massively bleeding internally or externally, acidosis - i.e., kidney failure, potassium derangements, etc). It could be possible that the patient had other causes of the cardiac arrest such as these non-intrinsic cardiac causes. Knowing that he is only 28, you can maybe invoke the possibility of an intrinsic cardiac event such as myocardial ischemia from an Acute MI. Even then, it's not a situation where the stroke actually caused the asystolic event or cardiac arrest.

Oh please The OP asked if it COULD- didn't ask for an autopsy

[Corey Narry, MSN, RN, NP]

Oh please The OP asked if it COULD- didn't ask for an autopsy

ha ha ha...actually there is a rare form of cardiomyopathy that can be caused by a stroke specifically a Sub-Arachnoid Hemorrhage. It's now called Neurogenic Stress Cardiomyopathy or Takotsubo Cardiomyopathy. That could well have led to this patient's demise.

[xtxrn, ASN, RN]

ha ha ha...actually there is a rare form of cardiomyopathy that can be caused by a stroke specifically a Sub-Arachnoid Hemorrhage. It's now called Neurogenic Stress Cardiomyopathy or Takotsubo Cardiomyopathy. That could well have led to this patient's demise.

In a 28y/o?? And that quickly? It sounded like it was less than 24 hours, or in that neighborhood :) Interesting :) Always good to learn !

[CCL RN, RN]

ha ha ha...actually there is a rare form of cardiomyopathy that can be caused by a stroke specifically a Sub-Arachnoid Hemorrhage. It's now called Neurogenic Stress Cardiomyopathy or Takotsubo Cardiomyopathy. That could well have led to this patient's demise.

See takotsubo syndrome all the time in the cath lab...or I should say, see it all the time at 2am.

[xtxrn, ASN, RN]

See takotsubo syndrome all the time in the cath lab...or I should say, see it all the time at 2am.

Well, I'm definitely not a cardiac buff - much more into neuro- good to know !!

[CCL RN, RN]

Well, I'm definitely not a cardiac buff - much more into neuro- good to know !!

I see it come in as a STEMI, never associated a neuro event with it. But I'm no neuro buff :)

[xtxrn, ASN, RN]

I see it come in as a STEMI, never associated a neuro event with it. But I'm no neuro buff :)

Since I'm said non-cardiac person, what is STEMI ??? I'll trade ya that for a JCD!!