Heart Disease and Stroke

A Heart Disease is described as a problem with the heart and blood vessel. There are many types of cardiovascular diseases and most of them are related to a pathophysiological process called Atherosclerosis.

Atherosclerosis is a process that occurs when a substance (called an atherosclerotic plague) or sometimes a blood clot accumulates and builds up inside of the walls of the arteries. As this plague accumulates overtime, it will cause narrowing of the vessel and decreased function i.e. causing difficulty for effective blood circulation and eventually result in a heart attack or stroke. Try to picture it as a clogged-up pipe drain, a clogged drain will eventually give you low or no supply of water.

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A Heart attack occurs when the blood supply to a certain part of the heart is stopped or blocked by a blood clot. Since the best nutrient for the heart i.e blood supply and oxygen is cut off completely, that part of the heart will begin to starve and die. The good news is that complete cell death can be prevented during an attack. How? It is discussed below.

WHO defines stroke as a neurological defect of cerebrovascular cause that persists beyond 24hrs or is interrupted by death within 24hrs.

 Risk factors for stroke

  1. High Blood Pressure
  2. Diabetes
  3. Heart diseases eg Coronary heart disease, Heart Failure, cardiomyopathy and A. Fib
  4. Smoking (even second-hand smoking)
  5. Age: Mostly in people > 60 years old
  6. Gender: Males are more likely than females
  7. Race and ethnicity: more likely Africans, African-Americans, American-Indians, Alaska Natives
  8. Genetic predisposition or family history
  9. Alcohol and illegal drug use (cocaine, amphetamines etc)
  10. Medical conditions such as Sickle cell disease, DIC, Vasculitis, high levels of von Willebrand factor etc
  11. Obesity and lack of any physical exercise
  12. Increased cholesterol/lipid levels (hypercholesterolemia/hyperlipidemia)
  13. Stress and Severe depression
  14. In people who have had a heart attack or a cardiac bypass surgery, the use of nonsteroidal anti-inflammatory drugs(NSAIDS) may increase the risk of a stroke. Eg of common NSAIDS are Ibuprofen and Naproxen for a long time except Aspirin (because it is effective for the early treatment of acute ischemic stroke).

A Mediterranean lifestyle and certain medications like lipid lowering drugs can reduce the risk of stroke. But sometimes about 30-40 % of the population can have a stroke without a known origin. This is called cryptogenic.

 

Classification of Stroke

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  1. Ischemic stroke: This is the most common type about 89 %. It is caused by blockage and interruption of blood supply to the vessel. Ischemia is what happens when the heart muscle doesn’t get enough oxygen. It dies. No oxygen means cell death.
  2. Haemorrhagic stroke: It is less common. About 15 % of all strokes. This happens due to rupture of a blood vessel which can be either a brain aneurysm, abnormal vessel structure or trauma. How? Picture this, the blood vessel bursts open, releasing blood and other components. Then it spills into the brain or around the brain causing an increase in brain pressure and swelling of the brain tissue, subsequently damaging brain cells and tissue.

A transient ischemic attack (TIA) — sometimes known as a mini stroke (is a temporary period of symptoms similar to those you’d have in a stroke). A temporary decrease in blood supply to part of your brain causes TIAs, which may last as little as five minutes.

Like an ischemic stroke, a TIA occurs when a clot or debris blocks blood flow to part of your nervous system — but there is no permanent tissue damage and no lasting symptoms.

Seek emergency care even if your symptoms seem to clear up. Having a TIA puts you at greater risk of having a full-blown stroke, causing permanent damage later. If you’ve had a TIA, it means there’s likely a partially blocked or narrowed artery leading to your brain or a clot source in the heart.

It’s not possible to tell if you’re having a stroke or a TIA based only on your symptoms, you will need diagnostic analysis such as:

  • An echocardiography
  • An electrocardiography
  • A CT and MRI scan
  • Transcranial Doppler and duplex exams
  • Laboratory analysis such as platelet count and a lipid profile.

Even when symptoms last for under an hour, there is still a risk of permanent tissue damage.

A stroke is a medical emergency and immediate treatment is crucial. Early action can minimize brain damage and other complications.

Symptoms of stroke

Watch for these signs and symptoms if you think you or someone else may be having a stroke. Pay attention to when the signs and symptoms begin.

  • Trouble with speaking and understanding: You may experience confusion. You may develop sudden slur in your words or have difficulty understanding speech.
  • Paralysis or numbness of the face, arm or leg: You may develop sudden numbness, weakness or paralysis in your face, arm or leg. This often happens just on one side of your body. Try to raise both your arms over your head at the same time. If one arm begins to fall, you may be having a stroke. Also, one side of your mouth may droop when you try to smile. These are signs of focal neurological symptoms.
  • Trouble with seeing in one or both eyes: You may suddenly have blurred or blackened vision in one or both eyes, or you may see double.
  • Headache: A sudden, severe headache, may be accompanied by vomiting or dizziness
  • Trouble with walking: You may experience a loss of balance or loss of coordination.

Now, For First Aid assessment.

Think “FAST” and do the following:

Face – Ask the person to smile. Does one side of the face droop?

Arms – Ask the person to raise both arms. Does one arm drift downward? Or is one arm unable to rise up?

Speech – Ask the person to repeat a simple phrase. Is his or her speech slurred or strange?

Time – If you observe any of these signs, seek medical help immediately.

Note: And in case of presence of seizures, clear the surrounding area of harmful objects (put the person in a safe space), put a piece of cloth to try to protect the head of the person like a pillow and then put the person in a recovery position.

recovery position

Prevention of stroke 

Knowing your stroke risk factors, following your doctor’s recommendations and adopting a healthy lifestyle are the best steps you can take to prevent a stroke. If you’ve had a stroke or a transient ischemic attack (TIA), these measures might help prevent another stroke. The follow-up care you receive in the hospital and afterward also may play a role as well.

Many stroke prevention strategies are the same as strategies to prevent heart disease. In general, healthy lifestyle recommendations include:

  • Controlling high blood pressure (hypertension): This is one of the most important things you can do to reduce your stroke risk. If you’ve had a stroke, lowering your blood pressure can help prevent a subsequent TIA or stroke.
  • Stress management: Effective stress management can help reduce or prevent several health issues including stroke by helping to maintain your blood pressure in check. Regular visits to hospital can be a good addition too.
  • Lowering the amount of cholesterol and saturated fat in your diet: Eating less cholesterol and fat, especially saturated fat and trans fats, may reduce the plaque in your arteries. If you can’t control your cholesterol through dietary changes alone, your doctor may prescribe a cholesterol-lowering medication.
  • Quit tobacco use: Smoking raises the risk of stroke for smokers and nonsmokers exposed to secondhand smoke. Quitting tobacco use reduces your risk of stroke.
  • Controlling diabetes: You can manage diabetes with diet, exercise, weight control and medication.
  • Maintaining a healthy weight: Being overweight contributes to other stroke risk factors, such as high blood pressure, cardiovascular disease and diabetes. Losing as little as 10 pounds may lower your blood pressure and improve your cholesterol levels.
  • Eating a diet rich in fruits and vegetables: A diet containing five or more daily servings of fruits or vegetables may reduce your risk of stroke. Following the Mediterranean diet, which emphasizes olive oil, fruit, nuts, vegetables and whole grains, may be helpful.
  • Exercising regularly: Aerobic or “cardio” exercise reduces your risk of stroke in many ways. Exercise can lower your blood pressure, increase your level of high-density lipoprotein cholesterol, and improve the overall health of your blood vessels and heart. It also helps you lose weight, control diabetes and reduce stress. Gradually work up to 30 minutes of activity — such as walking, jogging, swimming or bicycling — on most, if not all, days of the week.
  • Stop alcohol intake: Alcohol can be both a risk factor and a protective measure for stroke. Heavy alcohol consumption increases your risk of high blood pressure, ischemic strokes and hemorrhagic strokes. However, drinking small to moderate amounts of alcohol, such as one drink a day, may help prevent ischemic stroke and decrease your blood’s clotting tendency. Alcohol may also interact with other drugs you’re taking. Talk to your doctor about what’s appropriate for you.
  • Avoiding illegal drugs: Certain street drugs, such as cocaine and methamphetamines, are established risk factors for a TIA or a stroke. Cocaine reduces blood flow and can narrow the arteries.

In case you have experienced any of these symptoms listed above, It is not advised to take any herbal medications that has not been medically approved by the FDA or any drug prescribed by a friend or relative. I know they mean well but avoid it and seek professional medical help. No matter the cost, your life is expensive.

Source:

Mayo Clinic

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