Cerebrovascular events are known to produce changes in the electrocardiogram (ECG). Whether or not these changes are actually reflective of myocardial damage has been the topic of much research. There are indications that these ECG changes result from an imbalance in the autonomic nervous system, resulting in a relative excess of sympathetic activity. This article provides an overview of the ECG and physiologic changes noted in patients with acute ischemic stroke and identifies subgroups that may be at high risk for developing these changes. Implications for nursing care are discussed.