BACKGROUND- Cardiac and pulmonary complications are by far the most common cause of secondary morbidity and mortality in patients with cerebrovascular disease.REVIEW SUMMARY- Immobility, dysphagia, and autonomic instability occur frequently in stroke patients and can predispose them to serious medical complications such as pneumonia, pulmonary embolism, and myocardial infarction. Cerebrovascular and coronary artery disease have similar risk factors and often co-exist; thallium stress testing of selected patients with ischemic stroke can identify patients at risk of secondary cardiac events. Neurogenic cardiac injury that presents with characteristic electrocardiographic changes and reversible left ventricular dysfunction on echocardiography occurs in nearly 10% of patients with aneurysmal subarachnoid hemorrhage. Aspiration pneumonia is a direct cause of mortality in 6% of stroke patients. Modified barium swallow with videofluoroscopy can identify patients at high risk of aspiration. The prevention, early detection, and treatment of deep venous thrombosis and pulmonary embolism can significantly reduce morbidity and mortality in patients who are immobilized after stroke.CONCLUSIONS- Early recognition and treatment of cardiac and pulmonary complications can lead to significant improvement in morbidity and mortality in patients with cerebrovascular disease.