Abstract: Objective: To investigate the clinical significance and mechanism of brain-heart syndrome (BHS) in the aged with acute stroke.Methods: The clinical data of 416 cases of BHS of the aged with acute stroke were analyzed retrospectively.Results: The incidence of BHS in the aged(38.6%) was higher than that in the young persons (17.4%)(P<0.01),and the occurrence of BHS in98% old patients was in the first week of stroke.The occurrence of BHS was associated with stroke type and lesion location.BHS was found more commonly in acute stroke of brain hemorrhage (76.5%) than in that of embolism(51.3%)(P<0.01).The features of BHS EKG were arrhythmia,similarity myocardial infarction and myocardial ischemia.The abnormality rate of myocardial enzyme was about 46.6%,and about 49% of BHS was associated with low potassium or sodium.The mortality rate of the aged with BHS was 30.29%,which was higher than that of the young persons with BHS(15.15%)and the aged without BHS(15.26%)(P<0.005).Conclusions: The key to the treatment of BHS of aged patients with acute stroke is early diagnosis,high ICP release,EKG monitoring,prevention of pump failure and timely adjustment of arrhythmia.