Patients with strokes and other neurological insults in the neurocritical care unit share similar risk factors as those in the cardiac care unit. These factors include coronary artery disease, vascular disease, diabetes, hypertension, smoking, and dyslipidemia. These patients often have prior history of myocardial infarction, underlying cardiomyopathy or valvular heart disease. As a result, cardiac abnormalities are common in the neurocritical care unit. These findings can vary from electrocardiographic (ECG) changes to biomarker abnormalities (troponin elevation) to severe hemodynamic collapse in the setting of arrhythmias and profound myocardial dysfunction. In a large study looking at patients with ischemic stroke, cardiac etiologies were the second most common cause of death after neurologic processes. High-risk ECG findings are predictive of cardiac death after stroke in addition to well-established clinical factors, such as congestive heart failure, poor renal function, diabetes, and severity of stroke [1].