STROKEA stroke is an interruption of the blood supply to any part of the brain. A stroke is sometimes called a "brain attack. A blood vessel carrying blood to the brain is blocked by a blood clot. This is called an ischemic stroke.(>80 %)
A blood vessel breaks open, causing blood to leak into the brain. This is a hemorrhagic stroke(<20 %)
If blood flow is stopped for longer than a few seconds, the brain cannot get blood and oxygen. Brain cells can die, causing permanent damage.
A blood vessel breaks open, causing blood to leak into the brain. This is a hemorrhagic stroke(<20 %)
If blood flow is stopped for longer than a few seconds, the brain cannot get blood and oxygen. Brain cells can die, causing permanent damage.
ISCHEMIC STROKE
This is the most common type of stroke. Usually this type of stroke results from clogged arteries, a condition called atherosclerosis. Fatty deposits collect on the wall of the arteries, forming a sticky substance called plaque. Over time, the plaque builds up. Often, the plaque causes the blood to flow abnormally, which can cause the blood to clot. There are two types of clots:
A clot that stays in place in the brain is called a cerebral thrombus.
A clot that stays in place in the brain is called a cerebral thrombus.
(A moving thrombus is an embolus)
A clot that breaks loose and moves through the bloodstream to the brain is called a cerebral embolism.
Another important cause of cerebral embolisms is
a type of arrhythmia called atrial fibrillation.
Other causes of ischemic stroke include endocarditis, an abnormal heart valve, and having a mechanical heart valve. A clot can form on a heart valve, break off, and travel to the brain. For this reason, those with mechanical or abnormal heart valves often must take blood thinner
HEMORRHAGIC STROKE
A second major cause of stroke is bleeding in the brain. This can occur when small blood vessels in the brain become weak and burst. Some people have defects in the blood vessels of the brain that make this more likely. The flow of blood after the blood vessel ruptures damages brain cells.
Intracerebral hemorrhage occurs when a diseased blood vessel within the brain bursts, allowing blood to leak inside the brain. (The name means within the cerebrum, or brain). The sudden increase in pressure within the brain can cause damage to the brain cells surrounding the blood. If the amount of blood increases rapidly, the sudden buildup in pressure can lead to unconsciousness or death. Intracerebral hemorrhage usually occurs in selected parts of the brain, including the basal ganglia, cerebellum, brainstem, or cortex.
What causes it? The most common cause of intracerebral hemorrhage is high blood pressure (hypertension). Since high blood pressure by itself often causes no symptoms, many people with intracranial hemorrhage are not aware that they have high blood pressure, or that it needs to be treated. Less common causes of intracerebral hemorrhage include trauma, infections, tumors, blood clotting deficiencies, and abnormalities in blood vessels (such as Arterioveinous Malformation or AVM). A ruptured blood vessel will leak blood into the brain, eventually causing the brain to compress due to the added amount of edema
Subarachnoid Hemorrhage
When a cerebral aneurysm ruptures, blood will fill the space surrounding the brain.
What is it? Subarachnoid hemorrhage occurs when a blood vessel just outside the brain ruptures. The area of the skull surrounding the brain (the subarachnoid space) rapidly fills with blood. A patient with subarachnoid hemorrhage may have a sudden, intense h
eadache, neck pain, and nausea or vomiting. Sometimes this is described as the worst headache of one's life. The sudden buildup of pressure outside the brain may also cause rapid loss of consciousness or death.
What causes it? Subarachnoid hemorrhage is most often caused by abnormalities of the arteries at the base of the brain, called cerebral aneurysms. These are small areas of rounded or irregular swellings in the arteries. Where the swelling is most severe, the blood vessel wall become weak and prone to rupture. urgical treatment of aneurysms involves placing clip on neck of aneurysm.
Who gets it? The cause of cerebral aneurysms is not known. They may develop from birth or in childhood and grow very slowly. Some people have not one, but several aneuryms. Subarachnoid hemorrhage can occur at any age, including teenagers and young adults. Subarachnoid hemorrhage is slightly more common in women than men.
Another important cause of cerebral embolisms is
a type of arrhythmia called atrial fibrillation.Other causes of ischemic stroke include endocarditis, an abnormal heart valve, and having a mechanical heart valve. A clot can form on a heart valve, break off, and travel to the brain. For this reason, those with mechanical or abnormal heart valves often must take blood thinner
HEMORRHAGIC STROKE
A second major cause of stroke is bleeding in the brain. This can occur when small blood vessels in the brain become weak and burst. Some people have defects in the blood vessels of the brain that make this more likely. The flow of blood after the blood vessel ruptures damages brain cells.
Intracerebral hemorrhage occurs when a diseased blood vessel within the brain bursts, allowing blood to leak inside the brain. (The name means within the cerebrum, or brain). The sudden increase in pressure within the brain can cause damage to the brain cells surrounding the blood. If the amount of blood increases rapidly, the sudden buildup in pressure can lead to unconsciousness or death. Intracerebral hemorrhage usually occurs in selected parts of the brain, including the basal ganglia, cerebellum, brainstem, or cortex.
What causes it? The most common cause of intracerebral hemorrhage is high blood pressure (hypertension). Since high blood pressure by itself often causes no symptoms, many people with intracranial hemorrhage are not aware that they have high blood pressure, or that it needs to be treated. Less common causes of intracerebral hemorrhage include trauma, infections, tumors, blood clotting deficiencies, and abnormalities in blood vessels (such as Arterioveinous Malformation or AVM). A ruptured blood vessel will leak blood into the brain, eventually causing the brain to compress due to the added amount of edema
Subarachnoid Hemorrhage
When a cerebral aneurysm ruptures, blood will fill the space surrounding the brain.
What is it? Subarachnoid hemorrhage occurs when a blood vessel just outside the brain ruptures. The area of the skull surrounding the brain (the subarachnoid space) rapidly fills with blood. A patient with subarachnoid hemorrhage may have a sudden, intense h
eadache, neck pain, and nausea or vomiting. Sometimes this is described as the worst headache of one's life. The sudden buildup of pressure outside the brain may also cause rapid loss of consciousness or death.What causes it? Subarachnoid hemorrhage is most often caused by abnormalities of the arteries at the base of the brain, called cerebral aneurysms. These are small areas of rounded or irregular swellings in the arteries. Where the swelling is most severe, the blood vessel wall become weak and prone to rupture. urgical treatment of aneurysms involves placing clip on neck of aneurysm.
Who gets it? The cause of cerebral aneurysms is not known. They may develop from birth or in childhood and grow very slowly. Some people have not one, but several aneuryms. Subarachnoid hemorrhage can occur at any age, including teenagers and young adults. Subarachnoid hemorrhage is slightly more common in women than men.
STROKE RISKS
High blood pressure is the number one reason that you might have a stroke. The risk of stroke is also increased by age, family history of stroke, smoking, diabetes, high cholesterol, and heart disease.
Certain medications increase the chances of clot formation, and therefore your chances for a stroke. Birth control pills can cause blood clots, especially in woman who smoke and who are older than 35.
Men have more strokes than women. But, women have a risk of stroke during pregnancy and the weeks immediately after pregnancy.
Cocaine use, alcohol abuse, head injury, and bleeding disorders increase the risk of bleeding into the brain.
The symptoms of stroke depend on what part of the brain is damaged. In some cases, a person may not even be aware that he or she has had a stroke.
Usually, a SUDDEN development of one or more of the following indicates a stroke:
Slurred speech, inability to speak or understand speech, difficulty reading or writing
Swallowing difficulties or drooling
Loss of memory
Vertigo (spinning sensation)
Personality changes
If one or more of these symptoms is present for less than 24 hours, it may be a transient ischemic attack (TIA). A TIA is a temporary loss of brain function and a warning sign for a possible future stroke
In diagnosing a stroke, knowing how the symptoms developed is important. The symptoms may be severe at the beginning of the stroke, or they may progress or fluctuate for the first day or two (stroke in evolution). Once there is no further deterioration, the stroke is considered completed.
During the exam, your doctor will look for specific neurologic, motor, and sensory deficits. These often correspond closely to the location of the injury in the brain. An examination may show changes in vision or visual fields, abnormal reflexes, abnormal eye movements, muscle weakness, decreased sensation, and other changes. A "bruit" (an abnormal sound heard with the stethoscope) may be heard over the carotid arteries of the neck. There may be signs of atrial fibrillation.
Tests are performed to determine the type, location, and cause of the stroke and to rule out other disorders that may be responsible for the symptoms. These tests include:
ECG (electrocardiogram) -- used to diagnose underlying heart disorders.
Echocardiogram -- used if the cause may be an embolus (blood clot) from the heart.
Carotid duplex (a type of ultrasound) -- used if the cause may be carotid artery stenosis (narrowing of the major blood vessels supplying blood to the brain).
Heart monitor -- worn while in the hospital or as an outpatient to determine if a heart arrhythmia (like atrial fibrillation) may be responsible for your stroke.
Cerebral (head) angiography -- may be done so that the doctor can identify the blood vessel responsible for the stroke. Mainly used if surgery is being considered.
Blood work may be done to exclude immune conditions or abnormal clotting of the blood that can lead to clot formation.
CT scan- well established stroke Treatment
A stroke is a medical emergency. Physicians have begun to call it a "brain attack" to stress that getting treatment immediately can save lives and reduce disability. Treatment varies, depending on the severity and cause of the stroke. For virtually all strokes, hospitalization is required, possibly including intensive care and life support.
The goal is to get the person to the emergency room immediately, determine if he or she is having a bleeding stroke or a stroke from a blood clot, and start therapy -- all within 3 hours of when the stroke began.
A stroke is a medical emergency. Physicians have begun to call it a "brain attack" to stress that getting treatment immediately can save lives and reduce disability. Treatment varies, depending on the severity and cause of the stroke. For virtually all strokes, hospitalization is required, possibly including intensive care and life support.
The goal is to get the person to the emergency room immediately, determine if he or she is having a bleeding stroke or a stroke from a blood clot, and start therapy -- all within 3 hours of when the stroke began.
IMMEDIATE TREATMENT
Thrombolytic medicine, such as tPA, breaks up blood clots and can restore blood flow to the damaged area. People who receive this medicine are more likely to have less long-term impairment. However, there are strict criteria for who can receive thrombolytics. The most important is that the person be examined and treated by a specialized stroke team within 3 hours of when the symptoms start. If the stroke is caused by bleeding rather than clotting, this treatment can make the damage worse -- so care is needed to diagnose the cause before giving treatment.
In other circumstances, blood thinners such as heparin and Coumadin are used to treat strokes. Aspirin may also be used.
Other medications may be needed to control associated symptoms. Pain killers may be needed to control severe headache. Medicine may be needed to control high blood pressure.
Nutrients and fluids may be necessary, especially if the person has swallowing difficulties. The nutrients and fluids may be given through an intravenous tube (IV) or a feeding tube in the stomach (gastrostomy tube). Swallowing difficulties may be temporary or permanent.
For hemorrhagic stroke, surgery is often required to remove pooled blood from the brain and to repair damaged blood vessels.
LONG-TERM TREATMENT
The goal of long-term treatment is to recover as much function as possible and prevent future strokes. Depending on the symptoms, rehabilitation includes speech therapy, occupational therapy, and physical therapy. The recovery time differs from person to person.
Certain therapies, such as repositioning and range-of-motion exercises, are intended to prevent complications related to stroke, like infections and bed sores. People should stay active within their physical limitations. Sometimes, urinary catheterization or bladder/bowel control programs may be needed to control incontinence.
The person's safety must be considered. Some people with stroke appear to have no awareness of their surroundings on the affected side. Others show indifference or lack of judgment, which increases the need for safety precautions. For these people, friends and family members should repeatedly reinforce important information, like name, age, date, time, and where they live, to help the person stay oriented.
Caregivers may need to show the person pictures, repeatedly demonstrate how to perform tasks, or use other communication strategies, depending on the type and extent of the language problems.
In-home care, boarding homes, adult day care, or convalescent homes may be required to provide a safe environment, control aggressive or agitated behavior, and meet medical needs.
Behavior modification may be helpful for some people in controlling unacceptable or dangerous behaviors.
Family counseling may help in coping with the changes required for home care. Visiting nurses or aides, volunteer services, homemakers, adult protective services, and other community resources may be helpful.
Outlook (Prognosis)
The long-term outcome from a stroke depends on the extent of damage to the brain, the presence of any associated medical problems, and the likelihood of recurring strokes.
Of those who survive a stroke, many have long-term disabilities, but about 10% of those who have had a stroke recover most or all function. Fifty percent are able to be at home with medical assistance while 40% become residents of a long-term care facility like a nursing home.
Possible Complications
Problems due to loss of mobility (joint contractures, pressure sores)
Permanent loss of movement or sensation of a part of the body
Bone fractures
Muscle spasticity
Permanent loss of brain functions
Reduced communication or social interaction
Reduced ability to function or care for self
Decreased life span
Side effects of medications
Aspiration
Malnutrition
Prevention of a Stroke:
The risk of stroke may be reduced with a healthy diet, control of high blood pressure, regular exercise, and by avoiding or quitting smoking. Follow your health care provider's recommendations for the treatment and prevention of heart disease. Forty percent of patients who have had a stroke or TIA will suffer a subsequent stroke within 5 years.
Quit Smoking
Smoking is a major risk factor for stroke. Patients should also avoid exposure to second-hand smoke. Many organizations recommend asking patients at every visit about smoking. Smoking is a chronic condition and often requires repeat therapy using more than one cessation technique.
Control Diabetes
People with diabetes should aim for fasting blood glucose levels of less than 110 mg/dl and hemoglobin A1C of less than 7%. Blood pressure goals should be 130/80 mm Hg or less.
Antiplatelet and Anticoagulant Medications for Preventing Stroke
Antiplatelet Drugs
Blood platelets are involved in blood clotting. Antiplatelets prevent clotting by blocking the activation of platelets. An antiplatelet drug -- most often aspirin -- is given within 48 hours of an ischemic stroke and continued in low doses as maintenance therapy. Some studies suggest that antiplatelet therapy can reduce the risk for a second stroke by 25%
Primary Prevention (to prevent a stroke from occurring)
People at high risk for heart disease should take a low-dose aspirin every day, unless they have medical reasons to avoid aspirin. (As an alternative to aspirin alone, your doctor may prescribe clopidogrel (Plavix 75mg) alone or aspirin plus extended release dipyridamole.) Aspirin may help to prevent strokes caused by blockage in the artery (ischemic stroke), but it may slightly increase the risk of strokes caused by bleeding in the brain (hemorrhagic stroke).
The American Heart Association recommends aspirin therapy (75 - 325 mg/day) for women over age 65 who are at risk for stroke. Women over age 65 who are at lower risk for stroke may consider taking aspirin every other day.
Aspirin therapy strictly to prevent strokes is not recommended for men who do not have heart disease.
Some younger patients with atrial fibrillation, or those for whom anticoagulants such as warfarin are not safe, are treated with aspirin 100mg or clopidogrel 75mg.
Secondary Prevention (to prevent another stroke after one has occurred).
Aspirin combined with sustained release dipyridamole in a fixed-dose combination given twice daily is often prescribed to prevent another stroke. Aspirin is not recommended when uncontrolled hypertension is present. Clopidogrel may be used if aspirin cannot be taken but it is not better than aspirin. Combining aspirin and clopidogrel together does not have any more benefit and increases the risk for another stroke.
Anticoagulant Drugs. Warfarin (Coumadin) is the main anticoagulant (“blood thinner”) drug used to prevent strokes in high-risk patients with atrial fibrillation. Warfarin carries a risk for bleeding, but for most patients, warfarin’s benefits far outweigh its risks. The risk for bleeding is highest when warfarin therapy is first started, with higher doses, and with long periods of treatment. Patients at risk for bleeding are usually older and have a history of stomach bleeding and high blood pressure. It is important that patients who take warfarin have their blood checked regularly to make sure that it does not become “too thin.” Blood that is too thin increases the risk for bleeding, while blood that is “too thick” increases the risk for blood clots and stroke. Prothrombin time (PT) and international normalized ratio (INR) tests are used to monitor blood coagulation.
People with atrial fibrillation, who are generally considered candidates for warfarin therapy, often have one or more of the following characteristics:
History of blood clots to the lungs, stroke, or transient ischemic attack
Have a blood clot in one of their heart chambers
Significant valvular heart disease
High blood pressure
Diabetes, with age older than 65 years
Left atrium (one of the chambers of the heart) is enlarged
Coronary artery disease
Heart failure
Diet and Weight Control
No randomized controlled trials have studied a direct relationship between diet and stroke. However, the relationship between diet and heart disease, unhealthy cholesterol and lipids, and high blood pressure seems to indicate that dietary recommendations for these disorders also may help prevent stroke. A healthy diet rich in fruits and vegetables and low in salt and saturated fats may significantly lower the risk for both ischemic and hemorrhagic stroke. For diet plans, the Mediterranean diet may be a particularly good choice for reducing the risk of stroke.
The goal of long-term treatment is to recover as much function as possible and prevent future strokes. Depending on the symptoms, rehabilitation includes speech therapy, occupational therapy, and physical therapy. The recovery time differs from person to person.
Certain therapies, such as repositioning and range-of-motion exercises, are intended to prevent complications related to stroke, like infections and bed sores. People should stay active within their physical limitations. Sometimes, urinary catheterization or bladder/bowel control programs may be needed to control incontinence.
The person's safety must be considered. Some people with stroke appear to have no awareness of their surroundings on the affected side. Others show indifference or lack of judgment, which increases the need for safety precautions. For these people, friends and family members should repeatedly reinforce important information, like name, age, date, time, and where they live, to help the person stay oriented.
Caregivers may need to show the person pictures, repeatedly demonstrate how to perform tasks, or use other communication strategies, depending on the type and extent of the language problems.
In-home care, boarding homes, adult day care, or convalescent homes may be required to provide a safe environment, control aggressive or agitated behavior, and meet medical needs.
Behavior modification may be helpful for some people in controlling unacceptable or dangerous behaviors.
Family counseling may help in coping with the changes required for home care. Visiting nurses or aides, volunteer services, homemakers, adult protective services, and other community resources may be helpful.
Outlook (Prognosis)
The long-term outcome from a stroke depends on the extent of damage to the brain, the presence of any associated medical problems, and the likelihood of recurring strokes.
Of those who survive a stroke, many have long-term disabilities, but about 10% of those who have had a stroke recover most or all function. Fifty percent are able to be at home with medical assistance while 40% become residents of a long-term care facility like a nursing home.
Possible Complications
Problems due to loss of mobility (joint contractures, pressure sores)
Permanent loss of movement or sensation of a part of the body
Bone fractures
Muscle spasticity
Permanent loss of brain functions
Reduced communication or social interaction
Reduced ability to function or care for self
Decreased life span
Side effects of medications
Aspiration
Malnutrition
Prevention of a Stroke:
The risk of stroke may be reduced with a healthy diet, control of high blood pressure, regular exercise, and by avoiding or quitting smoking. Follow your health care provider's recommendations for the treatment and prevention of heart disease. Forty percent of patients who have had a stroke or TIA will suffer a subsequent stroke within 5 years.
Quit Smoking
Smoking is a major risk factor for stroke. Patients should also avoid exposure to second-hand smoke. Many organizations recommend asking patients at every visit about smoking. Smoking is a chronic condition and often requires repeat therapy using more than one cessation technique.
Control Diabetes
People with diabetes should aim for fasting blood glucose levels of less than 110 mg/dl and hemoglobin A1C of less than 7%. Blood pressure goals should be 130/80 mm Hg or less.
Antiplatelet and Anticoagulant Medications for Preventing Stroke
Antiplatelet Drugs
Blood platelets are involved in blood clotting. Antiplatelets prevent clotting by blocking the activation of platelets. An antiplatelet drug -- most often aspirin -- is given within 48 hours of an ischemic stroke and continued in low doses as maintenance therapy. Some studies suggest that antiplatelet therapy can reduce the risk for a second stroke by 25%
Primary Prevention (to prevent a stroke from occurring)
People at high risk for heart disease should take a low-dose aspirin every day, unless they have medical reasons to avoid aspirin. (As an alternative to aspirin alone, your doctor may prescribe clopidogrel (Plavix 75mg) alone or aspirin plus extended release dipyridamole.) Aspirin may help to prevent strokes caused by blockage in the artery (ischemic stroke), but it may slightly increase the risk of strokes caused by bleeding in the brain (hemorrhagic stroke).
The American Heart Association recommends aspirin therapy (75 - 325 mg/day) for women over age 65 who are at risk for stroke. Women over age 65 who are at lower risk for stroke may consider taking aspirin every other day.
Aspirin therapy strictly to prevent strokes is not recommended for men who do not have heart disease.
Some younger patients with atrial fibrillation, or those for whom anticoagulants such as warfarin are not safe, are treated with aspirin 100mg or clopidogrel 75mg.
Secondary Prevention (to prevent another stroke after one has occurred).
Aspirin combined with sustained release dipyridamole in a fixed-dose combination given twice daily is often prescribed to prevent another stroke. Aspirin is not recommended when uncontrolled hypertension is present. Clopidogrel may be used if aspirin cannot be taken but it is not better than aspirin. Combining aspirin and clopidogrel together does not have any more benefit and increases the risk for another stroke.
Anticoagulant Drugs. Warfarin (Coumadin) is the main anticoagulant (“blood thinner”) drug used to prevent strokes in high-risk patients with atrial fibrillation. Warfarin carries a risk for bleeding, but for most patients, warfarin’s benefits far outweigh its risks. The risk for bleeding is highest when warfarin therapy is first started, with higher doses, and with long periods of treatment. Patients at risk for bleeding are usually older and have a history of stomach bleeding and high blood pressure. It is important that patients who take warfarin have their blood checked regularly to make sure that it does not become “too thin.” Blood that is too thin increases the risk for bleeding, while blood that is “too thick” increases the risk for blood clots and stroke. Prothrombin time (PT) and international normalized ratio (INR) tests are used to monitor blood coagulation.
People with atrial fibrillation, who are generally considered candidates for warfarin therapy, often have one or more of the following characteristics:
History of blood clots to the lungs, stroke, or transient ischemic attack
Have a blood clot in one of their heart chambers
Significant valvular heart disease
High blood pressure
Diabetes, with age older than 65 years
Left atrium (one of the chambers of the heart) is enlarged
Coronary artery disease
Heart failure
Diet and Weight Control
No randomized controlled trials have studied a direct relationship between diet and stroke. However, the relationship between diet and heart disease, unhealthy cholesterol and lipids, and high blood pressure seems to indicate that dietary recommendations for these disorders also may help prevent stroke. A healthy diet rich in fruits and vegetables and low in salt and saturated fats may significantly lower the risk for both ischemic and hemorrhagic stroke. For diet plans, the Mediterranean diet may be a particularly good choice for reducing the risk of stroke.
Some evidence suggests that diets rich in potassium may protect against stroke, mostly by reducing blood pressure but also possibly because of other mechanisms. Low potassium levels may increase the risk for stroke in certain people.
Salt Restriction. Although the effects of salt restriction are not entirely clear, a diet with less than or equal to 2,300 mg of sodium per day is recommended. (Restriction to 1,500 mg/day is recommended for middle-aged people and those with high blood pressure.)
Vitamins
Folic Acid and B Vitamins. Deficiencies in the B vitamins folate (known also as folic acid), B6, and B12 have been associated with a higher risk for heart disease in some studies. Such deficiencies produce higher blood levels of homocysteine, an amino acid that has been associated with a higher risk for heart disease, stroke, and heart failure. Researchers have been studying whether vitamin B supplements can reduce homocysteine levels and, consequently, heart disease risks.
Recent studies have indicated that while B vitamin supplements help lower homocysteine levels, they have no effect on heart disease outcomes. In studies, patients who have either recently had a heart attack or suffer from diabetes or heart disease show a similar number of heart attacks and strokes whether they took folic acid and B6 and B12 vitamins or received placebo. The vitamins seem to increase risks for patients who have a stent in their bodies. Some experts think that homocysteine may be a marker for heart disease rather than a cause of it. Newer approaches specifically designed for stroke patients are being evaluated.
Antioxidant Vitamins.
The effects of antioxidant vitamins and carotenoids (vitamins C or E, or beta carotene) on stroke have been studied extensively. Most studies have found that these vitamins do not help protect against stroke.
Alcohol and Caffeine
Alcohol. Mild-to-moderate alcohol use (one to seven drinks a week) is associated with a significantly lower risk for ischemic stroke, although not hemorrhagic stroke. Heavy alcohol use, particularly a recent history of drinking, is associated with a higher risk of both ischemic and hemorrhagic stroke.
Coffee.
In healthy people with normal blood pressure, drinking a couple of cups of coffee a day is unlikely to do any harm. Caffeine may actually have nerve-protecting properties that may help stroke survivors. Caffeine drinkers, however, might consider choosing tea, which may have beneficial nutrients, and people with existing hypertension should avoid caffeine altogether (since caffeine may increase the risk for stroke in this group).
Exercise
Exercise helps reduce the risk of atherosclerosis, which can help reduce the risk of stroke. Experts recommend at least 30 minutes of exercise on most, if not all, days of the week.
Hypertension is a disorder characterized by chronically high blood pressure. It must be monitored, treated, and controlled by medication, lifestyle changes, or a combination of both.
Reducing Blood Pressure
Reducing blood pressure is essential in stroke prevention. Lifestyle measures such as exercise, weight loss, and healthy diets are important for everyone. Drug therapy is recommended for people with hypertension who cannot control their blood pressure through lifestyle changes. Many different types of drugs are used to control blood pressure. They include ACE inhibitors, angiotensin-receptor blockers, beta-blockers, calcium andchannel blockers.
Risk Groups
Blood Pressure Stages (Systolic/Diastolic)
Prehypertension
(120 - 139/80 - 89)
Mild (Stage 1) Blood Pressure
(140 - 159/90 - 99)
Moderate-to-Severe (Stage 2) Blood Pressure
(Systolic pressure over 160 or diastolic pressure over 100)
Risk Group A
Have no risk factors for heart disease.
Lifestyle changes only. (Exercise and dietary program with regular monitoring.)
Year trial of lifestyle changes only. If blood pressure is not lower at 1 year, add drug treatments.
Lifestyle changes and medications.
Risk Group B
Have at least one risk factor for heart disease* (excluding diabetes) but have no target organ damage (such as in the kidneys, eyes, or heart, or existing heart disease).
Lifestyle changes only.
6-month trial of lifestyle changes only. If blood pressure is not lower at 6 months, add drug treatments.
Medications considered for patients with multiple risk factors.
Lifestyle changes and medications.
Risk Group C
Have diabetes with or without target organ damage and existing heart disease (with or without risk factors for heart disease).
Lifestyle changes and medications.
Lifestyle changes and medications.
Lifestyle changes and medications. Risk factors for heart disease include the following: family history of heart disease, smoking, unhealthy cholesterol and lipid levels, diabetes, being over 60 years old.
Lowering LDL and Raising HDL Cholesterol
In 2004, the National Cholesterol Education Program issued updated recommendations on how to control cholesterol levels. These guidelines emphasize that patients should lower their LDL (“bad”) cholesterol and recommend that more people take LDL-lowering medication. Lowering LDL cholesterol and raising HDL (“good”) cholesterol can significantly reduce the risks of heart disease, including stroke.
The doctor will start or consider medication, increase dosage of medication, or add new medication when:
LDL cholesterol is 190 mg/dL (5 mmol/l) or higher.
LDL cholesterol is 160 mg/dL (4 mmol/l) or higher AND patient has one risk factor for heart disease.
LDL cholesterol is 130 mg/dL (3.3 mmol?l)or higher AND patient has either diabetes or two other risk factors for heart disease.
LDL cholesterol is 100 mg/dL (2.6 mmol/l) or higher AND patient has heart disease or any other form of atherosclerosis. (If patient has diabetes, even without heart disease, medication may be considered for an LDL cholesterol of 100 mg/dL.)
LDL cholesterol is greater than 70 mg/dL (1.8 mmol/l)AND patient has had a recent heart attack or has known heart disease along with diabetes, current cigarette smoking, poorly controlled high blood pressure, or the metabolic syndrome (high triglycerides, low HDL, and obesity).
Risk factors for heart disease include:
Having a first-degree female relative diagnosed with heart disease before age 65 or a first-degree male relative diagnosed before age 55
Being male and over age 45 or female and over age 55
Cigarette smoking
Diabetes
High blood pressure
Metabolic syndrome (risk factors associated with obesity such as low HDL levels and high triglycerides)
Statins have become the most important LDL-lowering drugs. Brands include lovastatin 20,40 mg (Mevacor), pravastatin 20,40 mg (Pravachol), simvastatin 10,20,40,80 mg(Zocor), fluvastatin 20,40,80 mg(Lescol), atorvastatin 10,20,40,80 mg(Lipitor), and rosuvastatin 5,10,20 mg(Crestor). Research increasingly suggests that lowering LDL levels as much as possible is critical for preventing stroke and other heart disease problems. Analysis of data from many studies indicate that statins reduced the risk for heart problems by 60% and stroke by 17 - 25%.
Statins are proven to reduce the risk of ischemic stroke in people at increased risk for heart disease. (However, statins can increase the risk for the less-common hemorrhagic type of stroke.) Research suggests that they may also prevent stroke in patients without heart disease. However, current guidelines recommend that statins should be prescribed to patients without heart disease or high LDL (“bad” cholesterol) levels only if diabetes or other heart disease risk factors are also present.
Researchers are also investigating whether statins might be beneficial in preventing a second stroke in patients who have suffered a stroke or transient ischemic attack (TIA). Recent studies indicate that high-dose statin therapy may help reduce the risk of stroke recurrence and other heart events for patients who have had a prior stroke or TI
Atrial Fibrillation and Its Treatments
As discussed previously, patients with chronic or recurrent atrial fibrillation are treated with aspirin or warfarin) to prevent clots from forming. Attempts to restore or maintain normal heart rhythm may be attempted with anti-arrhythmic drugs, cardioversion procedures, or surgery to remove the defective area. However, recurrent episodes of atrial fibrillation often occur. Simply controlling the heart rate is increasingly considered the preferable approach for many patients.
Salt Restriction. Although the effects of salt restriction are not entirely clear, a diet with less than or equal to 2,300 mg of sodium per day is recommended. (Restriction to 1,500 mg/day is recommended for middle-aged people and those with high blood pressure.)
Vitamins
Folic Acid and B Vitamins. Deficiencies in the B vitamins folate (known also as folic acid), B6, and B12 have been associated with a higher risk for heart disease in some studies. Such deficiencies produce higher blood levels of homocysteine, an amino acid that has been associated with a higher risk for heart disease, stroke, and heart failure. Researchers have been studying whether vitamin B supplements can reduce homocysteine levels and, consequently, heart disease risks.
Recent studies have indicated that while B vitamin supplements help lower homocysteine levels, they have no effect on heart disease outcomes. In studies, patients who have either recently had a heart attack or suffer from diabetes or heart disease show a similar number of heart attacks and strokes whether they took folic acid and B6 and B12 vitamins or received placebo. The vitamins seem to increase risks for patients who have a stent in their bodies. Some experts think that homocysteine may be a marker for heart disease rather than a cause of it. Newer approaches specifically designed for stroke patients are being evaluated.
Antioxidant Vitamins.
The effects of antioxidant vitamins and carotenoids (vitamins C or E, or beta carotene) on stroke have been studied extensively. Most studies have found that these vitamins do not help protect against stroke.
Alcohol and Caffeine
Alcohol. Mild-to-moderate alcohol use (one to seven drinks a week) is associated with a significantly lower risk for ischemic stroke, although not hemorrhagic stroke. Heavy alcohol use, particularly a recent history of drinking, is associated with a higher risk of both ischemic and hemorrhagic stroke.
Coffee.
In healthy people with normal blood pressure, drinking a couple of cups of coffee a day is unlikely to do any harm. Caffeine may actually have nerve-protecting properties that may help stroke survivors. Caffeine drinkers, however, might consider choosing tea, which may have beneficial nutrients, and people with existing hypertension should avoid caffeine altogether (since caffeine may increase the risk for stroke in this group).
Exercise
Exercise helps reduce the risk of atherosclerosis, which can help reduce the risk of stroke. Experts recommend at least 30 minutes of exercise on most, if not all, days of the week.
Hypertension is a disorder characterized by chronically high blood pressure. It must be monitored, treated, and controlled by medication, lifestyle changes, or a combination of both.
Reducing Blood Pressure
Reducing blood pressure is essential in stroke prevention. Lifestyle measures such as exercise, weight loss, and healthy diets are important for everyone. Drug therapy is recommended for people with hypertension who cannot control their blood pressure through lifestyle changes. Many different types of drugs are used to control blood pressure. They include ACE inhibitors, angiotensin-receptor blockers, beta-blockers, calcium andchannel blockers.
Risk Groups
Blood Pressure Stages (Systolic/Diastolic)
Prehypertension
(120 - 139/80 - 89)
Mild (Stage 1) Blood Pressure
(140 - 159/90 - 99)
Moderate-to-Severe (Stage 2) Blood Pressure
(Systolic pressure over 160 or diastolic pressure over 100)
Risk Group A
Have no risk factors for heart disease.
Lifestyle changes only. (Exercise and dietary program with regular monitoring.)
Year trial of lifestyle changes only. If blood pressure is not lower at 1 year, add drug treatments.
Lifestyle changes and medications.
Risk Group B
Have at least one risk factor for heart disease* (excluding diabetes) but have no target organ damage (such as in the kidneys, eyes, or heart, or existing heart disease).
Lifestyle changes only.
6-month trial of lifestyle changes only. If blood pressure is not lower at 6 months, add drug treatments.
Medications considered for patients with multiple risk factors.
Lifestyle changes and medications.
Risk Group C
Have diabetes with or without target organ damage and existing heart disease (with or without risk factors for heart disease).
Lifestyle changes and medications.
Lifestyle changes and medications.
Lifestyle changes and medications. Risk factors for heart disease include the following: family history of heart disease, smoking, unhealthy cholesterol and lipid levels, diabetes, being over 60 years old.
Lowering LDL and Raising HDL Cholesterol
In 2004, the National Cholesterol Education Program issued updated recommendations on how to control cholesterol levels. These guidelines emphasize that patients should lower their LDL (“bad”) cholesterol and recommend that more people take LDL-lowering medication. Lowering LDL cholesterol and raising HDL (“good”) cholesterol can significantly reduce the risks of heart disease, including stroke.
The doctor will start or consider medication, increase dosage of medication, or add new medication when:
LDL cholesterol is 190 mg/dL (5 mmol/l) or higher.
LDL cholesterol is 160 mg/dL (4 mmol/l) or higher AND patient has one risk factor for heart disease.
LDL cholesterol is 130 mg/dL (3.3 mmol?l)or higher AND patient has either diabetes or two other risk factors for heart disease.
LDL cholesterol is 100 mg/dL (2.6 mmol/l) or higher AND patient has heart disease or any other form of atherosclerosis. (If patient has diabetes, even without heart disease, medication may be considered for an LDL cholesterol of 100 mg/dL.)
LDL cholesterol is greater than 70 mg/dL (1.8 mmol/l)AND patient has had a recent heart attack or has known heart disease along with diabetes, current cigarette smoking, poorly controlled high blood pressure, or the metabolic syndrome (high triglycerides, low HDL, and obesity).
Risk factors for heart disease include:
Having a first-degree female relative diagnosed with heart disease before age 65 or a first-degree male relative diagnosed before age 55
Being male and over age 45 or female and over age 55
Cigarette smoking
Diabetes
High blood pressure
Metabolic syndrome (risk factors associated with obesity such as low HDL levels and high triglycerides)
Statins have become the most important LDL-lowering drugs. Brands include lovastatin 20,40 mg (Mevacor), pravastatin 20,40 mg (Pravachol), simvastatin 10,20,40,80 mg(Zocor), fluvastatin 20,40,80 mg(Lescol), atorvastatin 10,20,40,80 mg(Lipitor), and rosuvastatin 5,10,20 mg(Crestor). Research increasingly suggests that lowering LDL levels as much as possible is critical for preventing stroke and other heart disease problems. Analysis of data from many studies indicate that statins reduced the risk for heart problems by 60% and stroke by 17 - 25%.
Statins are proven to reduce the risk of ischemic stroke in people at increased risk for heart disease. (However, statins can increase the risk for the less-common hemorrhagic type of stroke.) Research suggests that they may also prevent stroke in patients without heart disease. However, current guidelines recommend that statins should be prescribed to patients without heart disease or high LDL (“bad” cholesterol) levels only if diabetes or other heart disease risk factors are also present.
Researchers are also investigating whether statins might be beneficial in preventing a second stroke in patients who have suffered a stroke or transient ischemic attack (TIA). Recent studies indicate that high-dose statin therapy may help reduce the risk of stroke recurrence and other heart events for patients who have had a prior stroke or TI
Atrial Fibrillation and Its Treatments
As discussed previously, patients with chronic or recurrent atrial fibrillation are treated with aspirin or warfarin) to prevent clots from forming. Attempts to restore or maintain normal heart rhythm may be attempted with anti-arrhythmic drugs, cardioversion procedures, or surgery to remove the defective area. However, recurrent episodes of atrial fibrillation often occur. Simply controlling the heart rate is increasingly considered the preferable approach for many patients.
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