Tag: stroke

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Controlling Hypertension Means Preventing Stroke

When was the last time you had your blood pressure checked?

Last week, I wrote in my column that we should learn to recognize early signs of stroke because if you receive clot busting medications within three to 4.5 hours then your chance of survival and living without disability is considerably improved.

So, what can you do to prevent stroke?

There are many things you can do to prevent stroke. One of the most import things you can do is to keep your blood pressure under control. Especially, in the current worsening economic situation.

We know that anxiety does not cause permanent high blood pressure but it can cause dramatic temporary spikes of high blood pressure which can cause damage to our blood vessels and vital organs like heart and kidneys. It can damage the brain and retina. Persistent or recurrent anxiety can make us prone to picking up bad habits like smoking, drinking or eating too much unhealthy food. Combination of these factors can increase our risk of high blood pressure.

Nearly two-thirds of all cases of stroke and one-half of all cases of coronary heart disease are directly related to hypertension. What is scarier is that most cases of hypertension either go undiagnosed or untreated. That is why it is called a silent killer. You may have high blood pressure but may not have any symptoms.

World Health Organization says that hypertension causes seven million premature deaths worldwide each year. Hypertension affects 22 percent of Canadians. It is estimated that 25 percent of the 42 million people with high blood pressure in the United States are unaware that they have hypertension. It is a ticking but silent time bomb ready to explode any time.

The incidence of hypertension increases with age. Most elderly Canadians have high blood pressure – probably due to thickening of blood vessels. No cause is identified in 80 to 95 percent of people with hypertension. This is known as idiopathic or essential hypertension. Others have hypertension due to primary disease of kidneys or due to certain hormonal disorders.

We eat too much and we do not exercise enough. Our blood vessels become harder and less compliant with age. When the blood is pumped out of the heart into less compliant blood vessels, the blood pressure goes up. So the heart has to work harder – and eventually it becomes tired, weak and fails. It silently causes damage to our vital organs and eventually results in heart attack, congestive heart failure, stroke, kidney failure and blindness.

Normally, systolic blood pressure should be less than 140 mm Hg (mercury) and diastolic pressure of less than 90 mm Hg. Blood pressure is lowest in the early morning, rises as the day progresses, and then dips down during the night and earliest hours of the morning.

Hypertension can be prevented and treated with lifestyle changes – with or without medication. Eat a healthy diet, lose weight if you are overweight, do not smoke, limit alcohol intake, eat a low salt diet, minimize sugar intake, do regular exercise, relax and learn to manage stress with laughter and meditation.

If your doctor wants you take pills to control your blood pressure then make sure you take it regularly. Research has shown that 50 per cent of the patients with high blood pressure discontinue their antihypertensive medications by the first year. This is no good.

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There Are New Guidelines For Stroke Management

“During a BBQ, a friend stumbled and took a little fall – she assured everyone that she was fine (they offered to call paramedics) … she said she had just tripped over a brick because of her new shoes. They got her cleaned up and got her a new plate of food. While she appeared a bit shaken up, Ingrid went about enjoying herself the rest of the evening.
Ingrid’s husband called later telling everyone that his wife had been taken to the hospital. Ingrid passed away at 6:00 pm. She had suffered a stroke at the BBQ. Had they known how to identify the signs of a stroke, perhaps Ingrid would be with us today. Some don’t die … they end up in a helpless, hopeless condition instead.

A neurologist says that if he can get to a stroke victim within three hours he can totally reverse the effects of a stroke … totally. He said the trick was getting a stroke recognized, diagnosed, and then getting the patient medically cared for within 3 hours, which is tough.”

Above two paragraphs are taken from an email sent to me by a friend in Calgary. It is not an uncommon story. Most people know somebody who has been paralyzed or killed by stroke. The good news is there is lot of research going on to prevent stroke. “Research in stroke care is generating new information at a rate that challenges our ability to effect health-system change in a timely manner,” says an article in the Canadian Medical Association Journal (CMAJ).

What is new now is the time window for delivery of thrombolytic therapy (clot buster) for acute ischemic stoke has been extended, from three to 4.5 hours after the onset of stroke symptoms. The CMAJ article says that for a person with stroke, “time is brain,” and earlier treatment is associated with better outcomes. Even if a patient presents later than the 3-hour window, he or she should still be considered for clot busting therapy.

For a better outcome, acute stroke teams and emergency departments must continue to give priority to all suspected stroke patients and follow agreed-upon protocols. Rapid transportation, diagnosis and treatment go hand-in-hand in improving prognosis. Patients with suspected transient ischemic attack (sort of a temporary stroke) or minor stroke, if treated early, can minimize the risk of disability significantly to less than five per cent.

How can you recognize stroke early? If you are a victim of a stroke or you see somebody complaining of some strange symptoms then you can make a rapid diagnosis by following the following check-list:

S: Ask the individual to smile (there should be no drooping on one side)

T: Ask the person to talk (coherently) and stick tongue out to see if it deviates on one side.

R: Ask the person to raise both arms (there should be no weakness on either side).

If he or she has trouble with any one of these tasks, call 911 immediately and describe the symptoms to the dispatcher. Don’t worry if you are wrong. There is no penalty for that. But if you are right then you will save somebody’s life or prevent lifelong disability.

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Stroke Prevention

June is stroke month.

Stroke is the third leading cause of death. That means we should remind ourselves about the prevention and early recognition of stroke symptoms. Early recognition of stroke symptoms can lead to early treatment with clot busting drugs. That means you improve your chances of recovery from stroke’s disabling symptoms.

Heart and Stroke Foundation has been running ads which clearly tell the public “how to recognize the signs of stroke when you see them.” You should immediately call an ambulance if you recognize the following signs:
-weakness – sudden loss of strength or sudden numbness in the face, arm or leg, even if temporary
-trouble speaking – sudden difficulty speaking or understanding or sudden confusion, even if temporary
-vision problems – sudden trouble with vision, even if temporary
-headache – sudden severe and unusual headache
-dizziness – sudden loss of balance, especially with any of the above signs

Each year in Canada stroke occurs in 50,000 people and account for seven per cent of all deaths. About five per cent of men and women over the age of 65 have been affected by stroke. Strokes kill 45 per cent more women than men in Canada, says a report from the Heart and Stroke Foundation. One of the reasons is that women live longer than man. Patients with stroke require a lot of care and health care resources.

A stroke occurs when blood flow to the brain is blocked, either by blood clots or narrowed blood vessels, or when there is bleeding in the brain.

Can we prevent stroke?

Chronic conditions like atherosclerosis (hardening of the arteries), atrial fibrillation (irregular heart rhythm), hypertension, high cholesterol levels and diabetes can lead to stroke if not appropriately managed.

For example, about 26 per cent of Canadian adult men and 18 per cent of women have hypertension. But 40 per cent of such people are unaware they have hypertension. This is not good.

Some risk factors like age, gender and genetic factors cannot be changed. Physical inactivity, smoking and heavy use of alcohol increases the risk of stroke. These risk factors can be changed if a person so desires.

According to an article in the Canadian Medical Association Journal, several agents can be used to manage underlying disease to prevent stroke:
-antiplatelet agents like aspirin
-blood thinners like Coumadin
-control of high blood pressure with thiazides and ACE inhibitors
-reducing the cholesterol level with statin
-if indicated, surgery for correction of narrowing of carotid artery in the neck

These measures should be combined with increased physical activity, no smoking and reduction in the amount of alcohol consumed. So stroke can be prevented if we take control of our health and modify the risk factors.

In an acute situation, if you recognize the signs of stroke then call an ambulance. Timely administration of aspirin and clot busting drugs can significantly modify the outcome of stroke.

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Heart and Stroke

On Friday June 3, the Medicine Hat branch of the Heart and Stroke Foundation had their 12th annual golf classic at Medicine Hat Golf and Country Club. I was one of the 160 golfers to participate in this fundraising event.

It is a big event. After 18 holes of golf (even the rain stopped for six hours for uninterrupted golf!), sumptuous dinner and some exciting prizes, I drove home thinking about the hard work done by people behind the scenes.

Darlene Neigum, Area Manager, Heart and Stroke Foundation of Alberta, NWT & Nunavut and her band of volunteers and sponsors work tirelessly to make this event a great success. It is an event worth waiting for each year.

Heart disease and stroke are subjects close to my heart as I have a strong family history of cardiac problems. The subject is also close to the hearts of many Canadians as heart disease is the number one killer in this country and in all the Western countries.

Heart and Stroke Foundation has a very interesting website (www.heartandstroke.ca). There is a lot of information to read and digest for a healthy heart.

Heart disease is usually a progressive disease occurring over many years. It is usually a result of bad genes and/or mismanagement of risk factors.

There are certain risk factors which we can influence in a positive way and there are some which are beyond our control. The risk factors that we can influence are:
-High blood cholesterol
-High blood pressure
-Lifestyle factors (lack of exercise, being overweight, smoking, drinking too much alcohol, stress) and
-Diabetes

The risk factors that we cannot change are:

-Age and gender (55+ for women, 45+ for men)
-Ethnic descent (African, South Asian, and First Nation populations are at higher risk)
-Family medical history – heart attack or stroke before age 65, angina, tendency to develop high blood cholesterol or blood pressure

Risk factors for stroke are very similar to heart disease. The best way to prevent heart disease and stroke is to work toward pursuing a healthy lifestyle. This includes daily exercise, eating a healthy dose of fruits and vegetables, keeping our weight within an acceptable range for our age and height, never to start smoking, drinking minimal amount of alcohol, and learning to manage stress.

Pursuing a healthy lifestyle will help control other risk factors such as diabetes, high blood pressure and high cholesterol level. It is important to see a family physician on a regular basis and have these risk factors checked.

To pursue a healthy lifestyle is not easy or cheap. It requires significant amount of sacrifice and time commitment. It is a question of making choices. Not always easy to do that.

The volunteers with the Heart and Stroke Foundation make sacrifices and time commitment to organize fundraising events so that money can be spent on research and education to help people like me who are at a high risk for heart disease and stroke. In return we owe it to ourselves and our families to make a commitment to pursue a healthy lifestyle. Summer is a good time to do that.

Thought for the week:

“Even if we can’t be happy, we must always be cheerful.” – Irving Kristol.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!