Abstract: Cardiovascular complications triggered by stroke are known as stroke-heart syndrome (SHS). Emerging evidence indicates that stroke triggers dysfunction of the suprachiasmatic nucleus (SCN) through direct neural injury or indirect regulatory pathways, leading to disruption of the endogenous circadian rhythm system. This circadian disruption manifests as sleep-wake cycle dysregulation. It serves as a critical pathological driver of secondary cardio-cerebrovascular events via three interconnected mechanisms: rhythmic dysregulation of immune-inflammatory responses, destabilization of gut microbial homeostasis, and neuroendocrine hormonal imbalance. This paper innovatively proposed a cascade response of "stroke-circadian disturbance-heart syndrome", systematically elaborating on the circadian rhythm-targeted therapy strategy for SHS, including rhythm regulation of immune inflammatory pathways, synergistic regulation of gut microbiota circadian clock, and melatonin rhythm remodeling, as well as the potential of traditional Chinese medicine intervention, providing new perspectives and ideas for clinical prevention and treatment of SHS.