Background CVAs (Cerebrovascular Accidents) are a leading cause of morbidity and mortality, often complicated by cardiovascular events like arrhythmias and sudden death, even without prior heart disease. These complications may stem from shared risk factors and arteriosclerosis. However, ECG changes in stroke patients are often overlooked. This study investigates the prevalence of ECG changes in acute stroke and their association with prognosis and mortality. Methods A longitudinal study was conducted over a 12-month period in the Department of Internal Medicine, Government TD Medical College, Alappuzha, a tertiary care center in South Kerala. The study included 100 patients aged over 18 years who were admitted with acute ischemic or hemorrhagic stroke within 48 hours of symptom onset. Stroke diagnosis was confirmed through clinical evaluation and neuroimaging (CT/MRI), with severity assessed using the NIHSS (National Institutes of Health Stroke Scale). A 12-lead ECG was performed at admission and repeated after three days. Patients were followed up for 30 days to evaluate neurological recovery and survival. Data were analyzed using SPSS software. Results Among the 100 patients (53 males and 47 females), ECG abnormalities were observed in 55%. The most frequent changes included T wave inversions (36%), QTc prolongation (23%), ST segment depression (23%), and atrial fibrillation (15%). ST depression showed a statistically significant association with mortality (p = 0.0001). Additionally, T wave inversion and QTc prolongation were significantly associated with poorer neurological outcomes at 30 days. Conclusion ECG changes were observed in 55% of acute stroke patients, with T wave inversion, ST depression, QTc prolongation, and atrial fibrillation being most common. ST depression, T wave inversion, and QTc prolongation were significantly associated with poor neurological recovery, while ST depression was strongly linked to increased mortality. These findings underscore the prognostic importance of routine ECG monitoring in stroke management.

Cerebrovascular Accidents; Electrocardiogram; Mortality; ST Depression; QTc Prolongation; T Wave Inversion; Atrial Fibrillation.