HEART NEWS

Stroke Awareness Month

Know the warning signs and talk with
your doctor about your risk of stroke

May is National Stroke Awareness Month. A stroke is an emergency – it can happen to anyone, at any time, and at any age. The National Stroke Association defines a stroke as “a brain attack.” Essentially, you have an instance where you’re losing blood flow to a part of the brain. Save a life by having a better understanding of stroke and by knowing what signs and symptoms to look for.
HEART NEWS

Stroke Awareness Month

Know the warning signs and talk with
your doctor about your risk of stroke

May is National Stroke Awareness Month. A stroke is an emergency – it can happen to anyone, at any time, and at any age. The National Stroke Association defines a stroke as “a brain attack.” Essentially, you have an instance where you’re losing blood flow to a part of the brain. Save a life by having a better understanding of stroke and by knowing what signs and symptoms to look for.

When blood flow to a part of your brain is stopped, you can have a stroke. Without oxygen and nutrients from the blood, brain cells die quickly. A stroke can damage your brain. It can even kill you.

Know the signs, act FAST

Dr. Lance Sullenberger explained the warning signs for stroke, “The symptoms that we tell patients to look out for are: slurring of speech or the inability to find words, weakness on one side of the body, or facial droop. If you see someone experience any of those symptoms call 9-11 for medical help immediately.”

The National Stoke Association has spotlighted the common stroke symptoms and the importance of acting quickly when we observe them. Sullenberger stresses on how we need to be ready to act to fast when we see the signs. “Now the real goal is to get patients who are having an active stroke into the emergency room within three hours of the onset of the symptoms of that stroke. Because if they having a stroke due to a blood clot, it can be broken up with medication and the chance of them ending up in a nursing home or dying is much less if they receive the medication.”

Dr. Robert Benton explains how a stroke event is similar to a heart attack. “Essentially for both of them you have an instance where you’re losing blood flow to a part of the brain or the heart. That is the common finding in both of them. In the heart, usually, this is caused by a cholesterol plaque that has become inflamed, ruptures because you are smoking, or because you have high blood pressure, and there’s a blood clot that forms and blocks blood flow to the heart. When the heart muscle doesn’t get blood, it dies. The brain is similar in that you can have plaque in your brain but the brain is also susceptible to other findings, that would be emboli that fly either from your neck, clotting breaking off from the arteries or the aorta, or one of the common causes of stroke called, atrial fibrillation (AFib).

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Luke Perry

Any time at any age

Luke Perry’s passing in February due to a massive stroke, dominated the headlines for weeks. As did John Singleton’s death in late April from hypertension, after being in a coma after suffering a major stroke. Both men were in their early 50’s – not the traditional age we think of for stroke patients. “People can have strokes at any age,” says Maryellen King, Nurse Practitioner at Capital Cardiology Associates. While there are more than 200,000 stroke cases in the US every year, making it the fifth leading cause of death in our country, the primary age affected is 60 years old and up. However, recent health trends have shown a growth in diagnosis with adults aged 41-60.

John Singleton

Causes of stroke

There are three main areas of stroke risk factors: lifestyle, medical, and genetics. Dr. Benton advises that we work with our doctor to identify our personal risk factors for stroke as we would with heart disease. “Heart attack and stroke can have very similar risk factors that lead to them. Smoking, hypertension, high cholesterol, diabetes, a sedentary lifestyle… all of those things can contribute to your risk.” Tobacco use and smoking double the risk of stroke when compared to a nonsmoker. Smoking increases clot formation, thickens blood, and increases the amount of plaque buildup in the arteries. “People can have a genetic pre-disposition to stroke: high blood pressure, arrhythmia, cholesterol levels, these things can be genetically programmed. Then you do yourself no big favor by smoking cigarettes, eating a poor diet, not exercising where you can compound your genetic disposition for stroke with poor or bad lifestyle choices. Those two factors really work together,” pointed out Benton.

Types of stroke

“There are different types of stroke, hemorrhagic (bleeding in the brain), embolic (a blood clot that travels),” says King. Hemorrhagic strokes are less common; only 15 percent of all strokes are hemorrhagic, but they are responsible for about 40 percent of all stroke deaths. They can occur as a cerebral aneurysm, a congenital malformation of the arteries in the brain that can rupture. “There is no way to know if you have an aneurysm or not. If it ruptures, you can have bleeding on the brain, and people can die from that. They would experience sudden severe headache, the bleeding in the brain, patients will say the worst headache of their life. It’s not a warning sign, that’s a symptom,” stated King.

The other form of stroke is called an ischemic stroke. This can happen when a sticky, fatty material called “plaque” builds up in a blood vessel in your brain. Plaque slows your blood flow. It may cause your blood to clot. This can stop the flow of blood completely. This kind of stroke can also happen when a clot travels to your brain from another part of your body, even if you don’t have plaque buildup in your vessels. The most common cause of this type of stroke is A-Fib (atrial fibrillation) when your heart has an abnormal rhythm that produces the opportunity for a clot to form in the left side of the heart, dislodge and travels up and through to the brain.

The other type of embolic stroke would be a patent foramen ovale (PFO) or some different kind of congenital hole in the right and left sides of the heart. “The sides of your heart are supposed to be separate; blood comes from the right side of the heart is pushed to the lungs. It comes to the left side of the heart and gets pushed through the body. When there is a hole between the two sides, clots form and can travel from one side to the other,” said King. Most patients with a PFO do not have any symptoms. However, the condition may play a role in migraine headaches and it increases the risk of stroke, transient ischemic attack and heart attack.

Advances in testing

For patients who present stroke symptoms: Numbness or weakness in your face, arm, or leg, especially on one side. Confusion or trouble understanding other people. Difficulty speaking. Trouble seeing with one or both eyes. Problems walking, staying balanced, or loss of coordination. Dizziness. Severe headaches that come for no reason; there are testing procedures. “The only way to find the holes in the heart would be with an echocardiogram, an ultrasound of the heart, to evaluate to see if a PFO has formed,” said King. Echo tests are performed by specially trained technicians at Capital Cardiology Associates. The test is painless, has no side effects, and usually takes an hour. “Using an echocardiogram (ECG) we can inject ‘fizz’ essentially, a trace amount of agitated saline that we call a ‘Bubble Study.’ These tiny bubbles can be seen on an ECG moving across the septum,” King explained. An ECG allows a physician to view the heart’s structure and check how the heart functions.

The other test available is the Transcranial Doppler (TCD), a non-invasive ultrasound method used to examine the blood circulation within the brain. A specially trained technician at Capital Cardiology Associates Imaging Suite performs this test to determine the amount of blood flow to specific areas of your brain. “The main reason that we started doing this is to detect a shunt or a hole in the heart,” shared Dr. Jeffrey Uzzilia of Capital Cardiology. “Patients that had a stroke, one of the reasons why they had a stroke that is not obvious at the time, is they can have a hole in their heart where a blood clot can form somewhere in the body and cross through that hole from the right side of the heart to the left. Once that blood clot is on the left side of the body it can travel anywhere in the body, including the brain and cause a stroke. Something like a PFO that everyone is born with, for most people it will close, for about 25% of people it will stay open. The TDP is the most accurate, sensitive test to detect that. It’s a very easy thing to see. There’s a good portion of patients, like Luke Perry, that you are shocked as to how young they are when they have a massive stroke,” said Dr. Uzzilia.

Prevention is the best cure

The good news is, 80% of strokes can be prevented. “Strokes are as preventable as a heart attack and they are actually quite similar,” states Mary Ellen King, Nurse Practitioner at Capital Cardiology Associates. “With heart attacks people know eat a healthy diet, manage cholesterol, exercise and a stroke is the same thing.” Ultimately, regular visits with your healthcare provider will assess and monitor your risk for stroke. Most importantly if you are over the age of 60 and haven’t been checked for AFib, see your doctor. “Most people with AFib don’t feel it. We find it on an EKG. Or a pacemaker, heart monitor, or they are wearing their FitBit or Apple Watch, whatever it is, they notice their heart rate is jumping all over the place and it’s faster than what it used to be.” Early detection of stroke is the biggest element in prevention. “The time piece of identifying stroke is so important because the longer that part of the brain goes without blood and oxygen supply, the worse the outcome is. Unfortunately, people live through strokes but they can be very debilitating and life altering,” explained King.

Written by: Michael Arce, Capital Cardiology Associates
Any medical information published on this website is not intended as a substitute for informed medical advice, and you should not take any action before consulting with a healthcare professional.