EXPLAINER: Understanding stroke and irreversible cardiocirculatory collapse, condition that killed the Pope

The Vatican on Monday announced that Pope Francis had passed away due to a stroke followed by irreversible heart failure, medically referred to as cardiocirculatory collapse.

The official certification of death was issued by Andrea Arcangeli, Director of the Directorate of Health and Hygiene of the Vatican City State.

According to the medical report, the Pope had a significant history of underlying health conditions, including acute respiratory failure caused by multimicrobial bilateral pneumonia, multiple bronchiectases (chronic lung infections leading to abnormal widening of the airways), high blood pressure (hypertension) and type II diabetes mellitus.

“His death was confirmed through electrocardiographic thanatography. I hereby declare, that the causes of death, to the best of my knowledge and judgment, are as stated above,” Arcangeli said.

Pope Francis died on Easter Monday, April 21, 2025.

What is a stroke?

A stroke occurs when the blood supply to part of the brain is suddenly interrupted, depriving brain tissue of oxygen and nutrients.

Strokes are medical emergencies and require immediate attention.

There are two primary types; Ischemic stroke (the most common), caused by a blood clot blocking an artery in the brain, and hemorrhagic stroke, which occurs when a weakened blood vessel ruptures and bleeds into the surrounding brain tissue.

Depending on the region of the brain affected and the severity of the event, a stroke can lead to localized damage or systemic complications.

When critical autonomic centers in the brainstem are affected—those responsible for regulating heartbeat, breathing, and blood pressure—the consequences can be rapidly fatal.

Symptoms of a stroke include sudden numbness or weakness (especially on one side), trouble speaking or understanding, vision problems, dizziness or loss of balance, and severe headache with no known cause.

How a stroke can lead to heart failure

In severe strokes, especially those involving the brainstem or those that result in brain swelling and increased intracranial pressure, the body may enter a state of physiological crisis.

This often includes a surge in stress hormones like adrenaline, disruption of the brain’s control over the heart and lungs, irregular heart rhythms (arrhythmias), respiratory failure and sudden drops in blood pressure.

This complex cascade can overwhelm the heart, leading to a condition called neurogenic heart syndrome or stroke-heart syndrome.

The heart becomes stunned—unable to pump efficiently—despite not being directly damaged by a cardiac event.

According to The Lancet Neurology, cardiac complications frequently occur in the first few days following an ischemic stroke.

These can manifest as myocardial injury (heart muscle damage), cardiac dysfunction (reduced pumping capacity) and arrhythmias (irregular heartbeat).

In some patients, especially those with preexisting cardiovascular conditions, these complications can escalate into irreversible cardiocirculatory collapse.

How to prevent a stroke

Lone Star Neurology says to prevent a stroke, one should maintain a healthy lifestyle, manage chronic conditions, have regular health check-ups, know their family history and stay hydrated.

It emphasises the need to safeguard cardiovascular health by understanding how to reduce the risk of stroke.

Lone Star Neurology notes that it is often a result of interrupted blood flow to the brain, which can have severe consequences.

What is Irreversible cardiocirculatory collapse?

Irreversible cardiocirculatory collapse is the terminal stage of cardiovascular failure.

It refers to a state where the heart is no longer able to pump blood effectively, causing a rapid decline in circulation to vital organs.

Key characteristics include severe drop in blood pressure, inability of the heart to maintain adequate cardiac output and progressive multi-organ failure, including the brain, kidneys, liver and lungs.

Once this stage is reached, resuscitation efforts are often unsuccessful, particularly in elderly or critically ill patients.

Its causes include massive myocardial infarction (heart attack), septic shock (overwhelming infection), anaphylaxis (severe allergic reaction), hypovolemia (severe blood or fluid loss) and advanced heart failure.

How it is diagnosed

Stroke can be diagnosed by CT scan (to distinguish between ischemic and hemorrhagic), MRI (more sensitive for early ischemia) and blood tests, ECG, carotid Doppler, and echocardiogram

Acute treatment

For Ischemic stroke, it includes tPA (alteplase), a clot-busting drug (within 4.5 hours of onset), mechanical thrombectomy: physically removing the clot (within 6–24 hrs in select patients) and antiplatelets/anticoagulants depending on cause.

For Hemorrhagic stroke, it includes controlling bleeding and reducing ICP, reversing anticoagulation if the patient is on blood thinners, and surgery: craniotomy or ventricular drainage.

A high-risk patient profile

Pope Francis’ medical history placed him in a high-risk category for both stroke and heart failure.

His chronic lung disease, previous infections, hypertension and diabetes all contributed to vascular and systemic stress.

These conditions likely reduced his body’s resilience in the face of a major cerebrovascular event.