WHAT IS HEART DISEASE? ( courtecy;- medicineNet.com )

WHAT IS HEART DISEASE?

Heart disease refers to conditions that involve the heart, its vessels, muscles, valves, or internal electric pathways responsible for muscular contraction. Common heart disease conditions include:

• Coronary artery disease
• Heart failure
• Cardiomyopathy
• Heart valve disease
• Arrhythmias

WHAT IS A HEART ATTACK?

When a coronary artery becomes blocked (usually by a blood clot), an area of heart tissue loses its blood supply. This reduction of blood can quickly damage and/or kill heart tissue, so quick treatments in an emergency department and/or catheterization suite are necessary to reduce the loss of heart tissue. Loss of heart tissue due to a blockage can cause symptoms such as chest pain, shortness of breath, weakness, and even death. Quick treatments have reduced the number of deaths from heart attacks in recent years; however, about 610,000 people die from heart disease in the US each year (1 in every 4 deaths) according to the CDC.

HEART ATTACK SYMPTOMS

The following are warning signs of a heart attack:

• Chest pain (may spread to the back, neck, arms and/or jaw)
• Dizziness
• Nausea, vomiting
• Rapid or irregular heartbeats
• Shortness of breath
• Some people may exhibit anxiety, indigestion and/or heartburn (some women may present with these as their predominant symptoms instead of chest pain)
• Weakness

HEART ATTACK SYMPTOMS IN WOMEN

Although some women present with symptoms of chest pain, a large number of women will not present with chest pain. Instead, women commonly have a different set of heart attack symptoms.

Know These Heart Attack Symptoms

• Arrhythmias
• Cough
• Heartburn
• Loss of appetite
• Malaise

Such symptoms in women cause delays in diagnosis if the symptoms are not considered as possible signs of heart disease. Delays in diagnosis can cause further damage to heart tissue or even death.

CORONARY ARTERY DISEASE SYMPTOMS

Coronary artery disease (CAD) occurs when plaque, a sticky substance, narrows or partially obstructs coronary arteries (like sticky material stopping up a straw) and can result in reduced blood flow. This reduced blood flow may cause chest pain (angina), a warning sign of potential heart problems such as a heart attack. Plaque may also trap small blood clots, completely blocking a coronary artery suddenly, resulting in a heart attack.

HOW PLAQUE, BLOOD CLOTS CAN CAUSE HEART ATTACK

Plaque can occur in coronary and other arteries (for example, carotid arteries). Some plaque may be hard or firm on the outside, but soft and mushy or sticky on the inside. If the hard shell-like area cracks open, blood components like platelets and small blood clots form a large clot and effectively block blood flow through the artery. The heart tissue downstream from the clot then suffers from lack of blood and becomes damaged or dies.

HEART ATTACK SYMPTOMS? CALL 9-1-1

If you or an individual develop symptoms of a heart attack, do not delay getting medical help. Call 911 or have someone call for you. Do not drive yourself or others to a hospital as 911 emergency medical services (EMS) personnel can begin basic treatment immediately. Delaying care can result in increased heart damage or death.

SUDDEN CARDIAC ARREST

A heart attack can cause other abnormalities besides blocking blood flow. For example, sudden cardiac death may occur when the heart’s electrical signals become erratic (arrhythmias). When the heart tissue that is responsible for regular electrical stimulus of heart muscle contractions is damaged, the heart stops effectively pumping blood. Death usually occurs in a few minutes after the heart stops pumping blood. Consequently, rapid coronary pulmonary resuscitation (CPR) and a restoration of the organized electrical activity (usually done by electric shock with a defibrillator) may restore effective pumping of blood. This can be lifesaving for some individuals.

ERRATIC HEART BEAT (ARRHYTHMIA)

Patients who notice that their heartbeats are abnormally fast, slow, or irregular may be experiencing irregular electrical impulses termed arrhythmias. They may also have symptoms of weakness, shortness of breath, and anxiety. Arrhythmias can alter, slow or even stop the heart’s ability to pump blood. Consequently, individuals with arrhythmias should seek emergency medical care especially if the arrhythmia is persistent or causes any symptoms related to heart attack symptoms such as chest pain.

CARDIOMYOPATHY

Cardiomyopathy is a condition indicated by abnormal heart muscle. Abnormal muscles make it harder for your heart to pump blood to the rest of the body.

Main Types of Cardiomyopathy

• Dilated (stretched and thinned muscle)
• Hypertrophic (thickened heart muscle)
• Restrictive (rare problem where the heart muscle does not stretch normally so the chambers do not fill with blood properly)

Signs and Symptoms of Cardiomyopathy

• Shortness of breath
• Fatigue
• Swelling of the feet, ankles and/or legs
• Coughing when lying down
• Dizziness
• Chest pain
• Irregular heartbeats

HEART FAILURE

Heart failure (also termed congestive heart failure) means the pumping action of the heart cannot meet the body’s demand for blood; it does not mean that the heart fails to pump - it does mean a failure in an aspect of the heart’s ability to complete an otherwise normal function. The symptoms and signs are almost identical to those seen with cardiomyopathy.

CONGENITAL HEART DEFECT

A congenital heart defect is a defect in the development of the heart as an organ that is usually first noticed at birth although some are not found until adulthood. There are many types of congenital heart defects and a few need no treatment, but others may need surgical repair. The American Heart Association lists at least 18 distinct types of congenital heart defects - many of them have additional anatomical variations.
Congenital heart defects put those patients at higher risk to develop arrhythmias, heart failure, heart valve infections, and other problems. A cardiologist (often a pediatric cardiologist) needs to be consulted on how to treat these defects. Recent advances have allowed surgeons to repair many of these defects so that the patient can go on to develop normally.

HEART DISEASE TESTING: EKG (ELECTROCARDIOGRAM)

The heart's electrical activity can be seen with an EKG (also termed ECG or electrocardiogram). EKGs are tests that provide important information to the physician about the heart rhythm, damage to the heart, or a heart attack, and may provide several other important pieces of information or clues to the patient's condition. In addition, EKGs can be compared to past and future EKGs to see changes in the heart’s electrical activity over time or after treatments.

HEART DISEASE TESTING: STRESS TEST

A stress test measures the ability of a person's heart to respond to the body's demand for more blood during stress (exercise or work). A continual measurement of the heart's electrical activity (a continual EKG or rhythm strip) is recorded along with the heart rate and blood pressure as a person's stress (exercise) is gradually increased on a treadmill. The information helps to show how well the heart responds to the body's demands and may provide information to help diagnose and treat problems. It can also be used to see the effects of treatment on the heart.

HEART DISEASE TESTING: HOLTER MONITOR

Many people have intermittent symptoms such as intermittent chest pain or occasional feelings of their heart beating faster or irregularly. However, their EKG does not show any changes. To detect these intermittent changes, a device called a Holter monitor can be worn for several days to record the hearts’ electrical function.
A Holter monitor is similar to a stress test, but it is worn for 1 or 2 days and provides a continual EKG-like recording of the heart's electrical activity during those days. Most doctors will ask the patient to keep a logbook of the time they do certain activities (for example, walking a mile starting at 7:20 AM and ending at 7:40 AM) and list any symptoms (for example, "experienced shortness of breath or rapid irregular heartbeats at 7:35 AM"). The Holter monitor's recordings can then be examined based on when certain symptoms occurred.

HEART DISEASE TESTING: CHEST X-RAY

Chest x-rays can provide limited information about the heart’s condition. Chest X-rays are used to provide the doctor with a view of both the heart and lungs to help determine if any abnormalities are present. These two X-rays show a relatively normal heart on the left. In the right X-ray, an enlarged heart (mainly the left ventricle) is easily seen and suggests the heart's main pumping chamber is not functioning normally. In addition, x-rays may show fluid accumulation in the lungs, possibly from heart failure.

HEART DISEASE TESTING: ECHOCARDIOGRAM

An echocardiogram is a real-time moving picture of a functioning heart made by using sound waves (ultrasound) to generate images. Echocardiograms use the same noninvasive technology used to examine the fetus during pregnancy. It can show how well heart chambers and heart valves are functioning (for example, effective or poor pumping action, blood flow through the valves), before and after treatments, as well as other features.

HEART DISEASE TESTING: CARDIAC CT SCAN

Specialized cardiac computerized tomography (CT) scans or ‘cardiac CTs’ can provide detailed 3-D images of the heart. The images can be manipulated to look for calcium buildup (plaque) in coronary arteries or provide images of such internal structures of the heart like valves or wall thickness. CTs can also be used to examine normal heart anatomy or congenital defects. The information from a CT can provide insight into several heart disease problems.

HEART DISEASE TESTING: CARDIAC CATHETERIZATION

Plaque in cardiac arteries can be a severe problem, even life-threatening, in some patients. Diagnosing plaque blockage of coronary arteries and treatment for blockages has improved the lives of many patients with coronary artery disease. Cardiac catheterization is a technique that may provide both diagnostic information and therapeutic methodology in one procedure. The technique is invasive.

How Cardiac Catheterization Works

• A thin tube is placed in a blood vessel in the leg or arm and threaded into the heart and into the opening of a coronary artery.
• Dye is put into the tube and goes into the artery.
• A special X-ray machine images the dye, showing narrowing or blockage of the artery.
• The same tube may be used with special tips to open the coronary artery by angioplasty (small balloon is inflated) or used to place a wire mesh (stent) that expands to hold the artery open.

LIVING WITH HEART DISEASE

Most types of heart disease are chronic but slowly progressive like heart failure or cardiomyopathy. They begin with minor symptoms that often slowly worsen and require long-term medical treatment.

Symptoms That May Resist Treatment

• Ankle swelling
• Fatigue
• Fluid retention
• Shortness of breath

Lifestyle changes may become necessary (for example, home oxygen, limited activity

HEART DISEASE TREATMENT: MEDICINES

Advances in medicines that can help reduce the symptoms and slow the damage of heart disease have helped the majority of heart disease patients. Drugs are available to do the following:

• Lower blood pressure (anti-hypertensives)
• Lower heartbeat rates (beta blockers)
• Lower cholesterol levels to reduce plaque (diet, statins)
• Help stabilize abnormal heart rhythms (ablation, cardiac pacers)
• Reduce or prevent clotting in coronary arteries (blood thinners)
• Improve the pumping ability of a person's heart with heart disease (inotropic agents)

HEART DISEASE TREATMENT: ANGIOPLASTY

Other treatments for heart disease involve special techniques like angioplasty and stent placement.

Angioplasty Step by Step

• A thin catheter or tube (stent) is placed in a coronary artery and is threaded through an obstruction like a clot.
• A balloon is inflated and pushes aside the obstruction.
• The balloon is then deflated leaving the artery unblocked, thus allowing good blood flow.
• Often, after angioplasty, an expandable mesh tube is then inserted and expanded, reinforcing the artery to keep it from collapsing.

HEART DISEASE TREATMENT: BYPASS SURGERY

Some patient's coronary arteries are not good candidates for angioplasty and/or stents. Such patients may benefit from another treatment technique termed bypass surgery. Bypass surgery occurs when a surgeon removes a blood vessel from one part of the body (chest, legs, or arms) and uses it to connect one open part of a coronary artery to another open part, thus bypassing the area that has blocked blood flow. Often the surgeon may need to bypass more than one artery.
The decision to try and stent a coronary artery versus doing bypass surgery is usually recommended to the patient by their cardiologist and a heart surgeon. Bypass surgery is usually done if coronary arteries are narrowed or blocked in multiple places.

WHO IS AT RISK FOR HEART DISEASE?

Health conditions, lifestyle, age, and family history may increase your risk for heart disease. Although men, even at a younger age, have a higher risk for heart disease than women, heart disease is still the number one killer of both sexes (about 611,000 total deaths/year). People with a family history of heart disease, who smoke, and who are obese have a higher risk of developing heart disease. About half of all Americans (47%) have at least one of three key risk factor for heart disease including high blood pressure, high cholesterol, or smoking.

CONTROLLABLE HEART DISEASE RISKS

Often, risk factors for heart disease can be managed or reduced through simple methods. Common risk factors for heart disease include the following:

Heart Diseases Risks You Can Control

• Diabetes
• Elevated cholesterol
• High blood pressure
• Lack of physical activity
• Stop smoking

These risk factors can be reduced simply by making healthy lifestyle choices and taking medications. Your primary care doctor can help you with your choices and medications.

SMOKING INCREASES HEART DISEASE RISK

Many researchers suggest one of the best things a person can do to decrease the risk of heart disease is to stop smoking cigarettes. Smoking increases a person's risk for heart disease from 2 to about 4 times greater than nonsmokers. Smoking can damage the heart muscle, its blood vessels, can raise blood pressure, increase carbon monoxide levels, and reduce oxygen available to heart tissue.
People who do not smoke but are exposed to second-hand smoke are at greater risk for heart disease than those not exposed to second-hand smoke. Although over 135,000 people die each year from heart disease related to smoking, it is never too late to quit smoking because once you quit, your risk of heart disease begins to drop almost immediately.

LIFE AFTER A HEART ATTACK

Don’t give up activities if you have a heart attack. If a person suffers a heart attack, it is still possible to develop a healthy lifestyle. Many doctors recommend that their patients participate in a cardiac rehab program and learn how to avoid cigarettes, develop a healthy diet, and become more active. All of these changes may help a person’s heart recover and function better and to reduce the chance of additional heart problems.

PREVENTING HEART DISEASE

Heart disease prevention and risk reduction is possible by living a healthy lifestyle. Basic components of a heart-healthy lifestyle include:

• Never smoke or stop smoking cigarettes (and using other tobacco products)
• Eat a nutritious diet (many vegetables and fruits, less fats, sugars, and meats)
• Get at least 30 minutes of exercise almost every day
• Avoid alcohol or consume no more than 1 drink per day for women and no more than 2 drinks per day for men
• If needed, achieve medical control of diabetes, high blood pressure, and cholesterol
• Encourage friends and family to help you. Maybe they could benefit from your good example!

HEART DISEASE AND DIET

A major key to preventing, recovering from, and slowing heart disease is a heart-healthy diet. Most heart doctors recommend the following foods.

Heart-Healthy Foods

• Fruits
• Legumes
• Vegetables
• Whole grains

Foods That May Help Reduce Cholesterol Levels

• Nuts
• Plant oils
• Seeds

Eating fish about twice a week is a good source of protein without the fats found in red meat. Some researchers have suggested that a more vegetarian-like diet may actually reverse some aspects of coronary artery disease like plaque size.
While heart disease is treatable by many methods, prevention or healing by living a reasonable lifestyle seems to be one of the best ways to reduce this widespread health problem.

Reviewed by Charles Patrick Davis, MD, PhD on 8/6/2016

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This tool does not provide medical advice. See additional information: 

© 1996-2018 WebMD, LLC. All rights reserved.
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Am I Having a Heart Attack? Symptoms of Heart Disease

HEART DISEASE

Heart disease is the leading cause of death in the U.S. – 1 in every 4 deaths is due to heart disease.
Severe chest pain may be an obvious sign something is wrong. But heart disease can be deadly because many people don't recognize some early signs and symptoms and they don't seek treatment until it may be too late.

HEART DISEASE WARNING SIGNS

Heart symptoms may not always be explicit so do not ignore any potential cardiac warning signs. Some warning signs not to ignore include: shortness of breath, heartburn, muscle soreness, painful hiccups, neck or upper back pain, or other symptoms discussed in this slide show. People with known heart disease or significant risk factors such as people over age 65, strong family history of heart disease, obesity, smokers, high cholesterol, high blood pressure, or diabetes should pay extra attention to any possible cardiac symptoms.

HEART DISEASE RISK FACTORS

It is important to pay attention to any symptoms that may indicate heart disease. Don't ignore them or wait for them to go away – see your doctor for testing and diagnosis. Many people mistake heart disease symptoms for heartburn or muscle soreness. If you have any cardiac disease risk factors, including being male, over age 65, have high cholesterol or high blood pressure, are obese, a smoker, diabetic, or have a family history of heart disease you need to pay extra attention to any potential heart disease symptoms.

1. ANXIETY

One symptom of an impending heart attack can be extreme anxiety. You may feel as if you are having a panic attack and experience shortness of breath, palpitations, chest pain, and dizziness. If you experience these symptoms go to an emergency room right away.

2. CHEST DISCOMFORT

Chest pain is a typical symptom of a heart attack. However, only about half of all women experiencing a heart attack may have chest pain. In addition, chest pain can be a result of other conditions that are not related to the heart.
When chest pain is heart-related it is often centered under the breastbone, slightly to the left of center. It can feel like extreme pressure on the chest, or just an uncomfortable sensation of pressure, squeezing, or fullness. Women may experience minor aches or even a burning sensation.
Any chest pain should be brought to the attention of your doctor who will help diagnose the cause.

3. COUGH

In heart failure, fluid may accumulate in the lungs, causing a persistent cough or wheezing. Sometimes the cough may produce bloody phlegm. If you have a chronic or worsening cough or wheezing that makes it hard to breathe or affects your daily life, see your doctor.

4. DIZZINESS

Heart attacks and heart rhythm abnormalities called arrhythmias can cause dizziness, lightheadedness, and even fainting. Many different conditions can cause these kinds of symptoms, so see a doctor to find out if heart disease is the cause of your dizziness.

5. FATIGUE

Fatigue is one of those symptoms that can be attributed to many different medical conditions. Sometimes women in particular to experience unusual fatigue during and in the days prior to a heart attack. Heart failure can cause people to feel tired all the time. When you are so fatigued it affects your daily function ion, it is time to see a doctor.

6. NAUSEA OR LACK OF APPETITE

Nausea, indigestion, vomiting, or abdominal swelling can occur during a heart attack. Sometimes the poor circulation due to a weak heart or blocked arteries can cause these symptoms. This is common in women, and often gets worse with activity and improves with rest. If you are experiencing nausea or lack of appetite that follows this pattern, see your doctor.

7. PAIN IN OTHER PARTS OF THE BODY

While chest pain is common in a heart attack, pain may occur in other areas of the body. Many people experience heart attacks as pain that begins in the chest and spreads to the shoulders, arms, back, neck, jaw, or abdomen. Men may experience pain in their left arm during a heart attack; women may experience pain in either arm or between the shoulder blades. The pain may come and go and may be mild or severe. If you experience pain similar to this, go to an emergency department immediately. You may be experiencing a heart attack.

8. RAPID OR IRREGULAR PULSE

An occasional "skipped" heartbeat may be no cause for concern. But if you have a rapid or irregular heart rate this could be a symptom of a heart attack, heart failure, or an arrhythmia. This rapid or irregular pulse may also be accompanied by weakness, dizziness, or shortness of breath. Seek medical attention immediately – some arrhythmias can lead to stroke, heart failure, or death without prompt medical intervention.

9. SHORTNESS OF BREATH

During a heart attack or heart failure, fluid may leak into the lungs, causing shortness of breath. People may feel breathless even at rest. Shortness of breath can be due to other conditions such as chronic obstructive pulmonary disease (COPD) but it can also be a sign of heart attack or heart failure.

10. SWEATING

Breaking out into a sudden sweat for no reason is actually a common symptom of a heart attack. Sweating profusely when you don't have a fever and are not exerting yourself or in a hot environment – especially if accompanied by other symptoms such as lightheadedness, shortness of breath nausea, or chest pain – may be a symptom of a heart attack.

11. SWELLING

When the heart is weakened it pumps blood less effectively, and this can lead to fluid retention that results in swelling (edema) of the lower extremities or abdomen. Heart failure can also cause sudden weight gain and loss of appetite.

12. WEAKNESS

Severe and unexplained weakness may be a sign of an impending heart attack. The heart is unable to pump enough blood to meet the body's needs. Blood gets diverted to the most critical organs such as the heart, lungs, and brain, and away from the muscles.

12 POSSIBLE HEART SYMPTOMS NEVER TO IGNORE - SUMMARY

If you notice any of the symptoms discussed in this slide show, see your doctor or go to an emergency department right away. If you have any risk factors for heart disease it is especially important to pay attention to your body and get any symptoms checked out by a doctor. Getting prompt medical attention may save your life!

Reviewed by Robert J. Bryg, MD on 7/27/2016

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This tool does not provide medical advice. See additional information: 

© 1996-2018 WebMD, LLC. All rights reserved.
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Stroke Causes, Symptoms, and Recovery

WHAT IS A STROKE?

When the brain’s blood supply is inadequate, a stroke results. Stroke symptoms (for example, loss of arm or leg function or slurred speech) signify a medical emergency because without treatment, blood-deprived brain cells quickly become damaged or die, resulting in brain injury, serious disability, or death. Call 9-1-1 if you notice stroke symptoms developing in someone.

STROKE SYMPTOMS

Initial symptoms of a stroke can occur in someone suddenly. Know these signs of a stroke:

• Difficulty speaking
• Difficulty understanding or confusion, especially with simple tasks
• Difficulty with muscle strength, especially on one side of the body
• Difficulty with numbness, especially on one side of the body
• Severe headache
• Vision changes (in one or both eyes)
• Difficulty with swallowing
• Facial droop on one side

SIGNS OF A STROKE

The F.A.S.T. test was designed in 1998 to help ambulance staff in the United Kingdom quickly assess stroke. It takes into account the most common symptoms of stroke and is designed to help quickly assess a stroke with very little training.

F.A.S.T. Test

• F means face -- If one side of the face droops, it’s a sign of a possible stroke
• A means arms -- If the person cannot hold both arms out, it’s another possible stroke sign
• S means speech -- Slurring words and poor understanding of simple sentences is another possible stroke sign
• T means time -- If any of the FAS signs are positive, it’s Time to call 9-1-1 immediately

STROKES AND THE BRAIN

Remember the FAST test for stroke. The “T” in FAST also means the longer the brain is blocked from its blood supply (usually due to a blood clot), the greater the brain damage possible.
For many patients, the time limit to diagnose and treat such a clot is usually within 3 hours (some clinicians suggest a bit longer). In some qualified patients, the use of a clot-busting drug may be used to dissolve the clot and restore blood flow. Not all patients qualify for this treatment. There are also some risks like bleeding associated with this treatment that may cause problems.
Strokes are a leading cause of long-term disability in people.

DIAGNOSING TYPES OF STROKES

There are two main types of strokes (ischemic and hemorrhagic) and they are treated differently. They are often emergently diagnosed by a head CT scan (or an MRI scan).

ISCHEMIC STROKE

This slide shows a CT scan of an ischemic stroke, which is responsible for about 80% to 90% of all strokes. Ischemic strokes are caused by clots that reduce or stop blood flow to the brain. The clot may develop elsewhere in the body and circulate to become lodged in a blood vessel in the brain, or the clot may originate in the brain.
Ischemic strokes are usually divided into two main subtypes: thrombotic and embolic.

Thrombotic Stroke

Nearly half of all strokes are thrombotic strokes. Thrombotic strokes are caused when blood clots form in the brain due to a diseased or damaged cerebral artery.

Embolic Stroke

Blood clots also cause embolic strokes. However, in the case of embolic strokes, the blood clot forms in an artery outside the brain. Often these blood clots start in the heart and travel until they become lodged in an artery of the brain. The physical and neurological damage embolic strokes cause is nearly immediate.

HEMORRHAGIC STROKE

This picture shows a hemorrhagic stroke using an MRI image. The circle insert outlines what composes a hemorrhagic stroke. A blood vessel in the brain breaks open and blood escapes into the brain under pressure, compressing other blood vessels and brain cells causing damage and death. This bleeding into the brain is difficult to stop and is more likely to be fatal. There are two types of hemorrhagic strokes: intracerebral and subarachnoid.

Intracerebral Stroke

“Intracerebral” means “within the brain,” and it refers to a stroke caused by a diseased blood vessel bursting within the brain. Intracerebral strokes are usually caused by high blood pressure.

Subarachnoid Stroke

A subarachnoid hemorrhage refers to bleeding immediately surrounding the brain in the area of the head called the subarachnoid space. The main symptom of a subarachnoid stroke is a sudden, severe headache, possibly following a popping or snapping feeling. Many factors can cause a subarachnoid stroke, including head injury, blood thinners, bleeding disorders and bleeding from a tangle of blood vessels known as an arteriovenous malformation.

MINI-STROKE (TIA)

"Mini-strokes" (also termed transient ischemic attacks or TIAs) are temporary blockages of blood vessels in the brain. TIAs can produce mild stroke symptoms that resolve. TIAs often occur before a stroke happens, so they serve as warning signs that the person may need stroke preventive therapy.

Mini Stroke Symptoms

• Confusion
• Weakness
• Lethargy
• Paralysis
• Facial droop
• Vision loss

Mini Stroke Treatment

Treatment for a mini-stroke may include medication, changes in lifestyle, and possibly surgery to reduce the chances of another stroke occurring.

WHAT CAUSES A STROKE?

Common causes of stroke come from blood vessels both outside and inside the brain. Atherosclerosis (hardening of the arteries) can occur when plaque (deposits of cholesterol, calcium, fat, and other substances) builds up and narrows the vessel making it easy for clots to form and further occlude the vessel. The clots can break free only to occlude smaller vessels inside the brain. The blood vessels inside the brain itself can accumulate this plaque. Occasionally, weakened vessels can burst and bleed into the brain.

STROKE PREVENTION: MANAGING MEDICAL CONDITIONS

Common conditions that increase a person's risk for strokes include high blood pressure, elevated cholesterol levels, diabetes, and obesity. People can reduce stroke risks by addressing these problems.

LIFESTYLE CHANGES

People can also reduce their stroke risk by altering some aspects of their lifestyle. For example, people who stop smoking, begin a consistent exercise program, and limit their alcohol intake (two drinks per day for men, one per day for women) can decrease their risk.

STROKE PREVENTION: DIET

One of the best ways to reduce stroke risk is to eat a diet that has low fat and low cholesterol to reduce the chance of plaque formation in blood vessels. Foods high in salt may increase blood pressure. Cutting back on calories can help reduce obesity. A diet that contains a lot of vegetables, fruits, and whole grains, along with more fish and less meat (especially red meat) is suggested to lower stroke risk.

UNCONTROLLABLE STROKE RISK FACTORS

Unfortunately, there are some risk factors that people cannot control, such as family history of strokes, gender (men are more likely to have a stroke), and race (African Americans, Native Americans, and Alaskan Natives all have increased risk for strokes). In addition, women who get strokes are more likely to die from the stroke than men.

EMERGENCY STROKE TREATMENT

Emergency stroke treatment depends on the type of stroke and underlying health of the patient. Ischemic strokes are treated by methods designed to remove (dissolve) or bypass a clot in the brain while hemorrhagic strokes are treated by attempts to stop the bleeding in the brain, control high blood pressure, and reduce brain swelling. Hemorrhagic strokes are more difficult to treat.

Aspirin

Aspirin is part of a group of drugs called antiplatelet agents. Antiplatelet agents like aspirin help prevent blood cell fragments from sticking together and forming clots, and are therefore helpful at preventing some forms of stroke. The American Heart Association recommends taking aspirin within two days of an ischemic stroke to reduce the stroke’s severity. For those who have had a mini-stroke, a doctor may recommend daily aspirin treatment.

TPA

TPA can be used to treat ischemic strokes. It is given through the arm as an IV, and helps dissolve blood clots and improve blood flow through areas of the brain blocked by clots. TPA may help if it is used within three hours of a stroke taking place.

STROKE RECOVERY

Strokes that cause long-term damage are usually severe and/or not treated or treated after large sections of the brain have been damaged or killed. The type of damage depends on where in the brain the stroke occurred (for example, the motor cortex for movement problems or the brain area that controls speech). Although some problems will be permanent, many people that do rehabilitation can regain some or many of the abilities lost in the stroke.

SPEECH THERAPY

If a stroke damages a person’s ability to use language and to speak or swallow, rehabilitation with a speech therapist, can help a person regain some or most of the abilities they lost initially with the stroke. For those who have severe damage, rehabilitation can provide methods and skills that can help a person to adapt and compensate for severe damage.

PHYSICAL THERAPY

Physical therapy is designed to improve a person’s strength, gross coordination, and balance. This rehabilitation helps people, after their stroke, regain their ability to walk and do other things like using stairs or getting out of a chair. Regaining fine motor skills like buttoning a shirt or using a knife and fork or writing a letter are activities that occupational therapy is designed to aid.

STROKE RECOVERY: TALK THERAPY

Some people have problems coping with their new disabilities after a stroke. It is common for people to have emotional reactions after a stroke. A psychologist or other mental health professional can help people adjust to their new challenges and situations. These professionals use talk therapy and other methods to help people with reactions such as depression, fear, worries, grief, and anger.

PREVENTING ANOTHER STROKE: LIFESTYLE

The methods previously discussed that may prevent or decrease a person’s stroke risk are essentially the same for people who have had a stroke (or TIA) and want to prevent or decrease their chances of having another stroke. In summary, quit smoking, exercise, and if obese, lose weight. Limit alcohol, salt, and fat intake and get into the habit of eating more vegetables, fruits, whole grains, and more fish and less meat.

PRESCRIBED MEDICATIONS AND SIDE EFFECTS

Medications are usually prescribed for people with a high risk of stroke. The medicines are designed to lower risk by inhibiting clot formation (aspirin, warfarin and/or other antiplatelet medicines). Also, antihypertensive medications can help by reducing high blood pressure. Medications have side effects so discuss these with you doctor.

PREVENTING ANOTHER STROKE: SURGERY

There are some surgical options for stroke prevention. Some patients have plaque- narrowed carotid arteries. The plaque can participate in clot formation in the artery and can even shed clots to other areas in the brain’s blood vessels. Carotid endarterectomy is a surgical procedure where the surgeon removes plaque from the inside of the arteries to reduce the chance of strokes in the future.

PREVENTING ANOTHER STROKE: BALLOON AND STENT

Some clinicians also treat plaque-narrowed carotid (and occasionally other brain arteries) with a balloon on the end of a narrow catheter. Inflating the balloon pushes plaque aside and increases the vessel’s lumen (opens up the vessel). This opened artery then is reinforced (kept open) by an expandable stent that, when expanded, becomes rigid.

LIFE AFTER A STROKE

About two-thirds of people (over 700,000) that have a stroke each year survive and usually need some level of rehabilitation. Some who get clot-busting drugs may recover completely, others will not. Many people who have disability after a stroke can function independently with therapy and rehabilitation methods. Although the risk of having a second stroke is higher after the first stroke, individuals can take the steps outlined in previous slides to reduce this risk.

Reviewed by William C. Shiel Jr., MD, FACP, FACR on 8/1/2016

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