Posted in Health, news

Stroke Deaths Increasing, Warns CDC

After decades of progress, the CDC warns that there has been an uptick in stroke deaths, especially among Hispanics and those living in the South.

In their MMWR, Morbidity and Mortality Weekly Report, the CDC reports the following:

Blacks experienced the highest stroke death rate compared with other racial/ethnic groups, and the stalling of the rate of decline among this group began in 2012. Among Hispanics, the stroke death rate trend reversed in 2013, changing from a 3.6% decline per year during 2000–2013, to a significant 5.8% increase per year during 2013–2015.

Although high blood pressure is one of the most significant risk factors for stroke, other causes cited by the CDC included obesity, diabetes and the flu.

Influenza has been shown to increase stroke risk, therefore flu shots have been shown to significantly lower risk.

Screening for stroke can be easy and painless.  Visit Life Line Screening for easy and affordable screening!

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What is a stroke?

A stroke occurs when an area of the brain does not get the proper oxygen and blood flow it needs. There are two major types of stroke.  Ischemic and Hemorrhagic.

Ischemic strokes are more common than the latter and occur when a clot prevents blood flow to part of the brain.  80% of all strokes fall under ischemic.  It is a likened to a heart attack, except the brain tissue is being deprived of blood and nutrients.  Plaques commonly arise from arteriosclerosis that break off travel to the smaller vessels of the brain.

Hemorrhagic strokes are less common and occur when there is a bleed of one of the brain vessels.  The bleed prevents blood flow into the brain since it is seeping outside the brain tissue, causing damage to nearby cells.  The bleeds could occur from high blood pressure or aneurysms that rupture.

What are the signs of a stroke?

Since a clot or bleed usually affect one area of the brain, we see symptoms on one side of the body, many times its contralateral (opposite) side.  We can also see central effects.  The symptoms of stroke include the following:

Weakness of one side of the body

Loss of balance

Numbness on one side of the body

Slurred speech

Vision issues

Headache

Facial droop

and more…..

How are strokes treated?

If the stroke was caused by a clot (ischemic) immediate treatment includes dissolving/removing the clot.   Aspirin is used initially and if within the proper time frame, tissue plasminogen activator (TPA).  These clots can also be surgically removed and arteries widened to bring blood flow to the brain.

With a hemorrhagic  stroke, we need to stop the bleed and improve flow to the brain.  Controlling the bleed, bypassing the vessel, “clogging” the aneurysm with techniques such as “coiling” (endovascular embolization) are sometimes utilized.

Time is of the essence, so its crucial to identify the warning signs and call 911 immediately.  The American Stroke Association uses the acronym “FAST” (Facial drooping, Arm weakness, Speech difficulty, and Time to call 911).  The sooner a stroke victim receives medical attention the better the prognosis.

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COURTESY OF THE AMERICAN STROKE ASSOCIATION

What are the risk factors for stroke?

The following put us at risk of having a stroke.

High blood pressure

Family history of stroke

Diabetes

Cardiovascular disease (artery clogging, such as the heart and carotid arteries)

Abnormal heart rhythms, such as atrial fibrillation

Smoking

Drugs

Obesity

Inactivity

Clotting disorder

Sleep apnea

Being older (greater than 55)

African-Americans appear to be more at risk than Caucasians and Hispanics

Men seem to be more affected than women

How do we prevent strokes?

Avoid the following:

Excessive drinking

Drug use

Tobacco products

Control blood pressure, sugar and cholesterol

Get evaluated by a medical provider if at risk for heart disease or stroke.

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network and Board Certified Family Physician

Posted in Health, news

Undiagnosed Atrial Fibrillation More Common in Seniors Than Thought

A recent study found 1 in 3 patients to have atrial fibrillation during cardiac monitoring who were never previously diagnosed.

The study suggests that many people may unknowingly be at risk for this deadly heart rhythm.

Those with atrial fibrillation are at increased risk for blood clots, stroke, heart failure, and much more.

The study authors looked at data provided by long-term cardiac monitor implants and found close to a third had undetected atrial fibrillation.  According to lead researcher, James Reiffel, cardiologist and professor at Columbia University College of Physicians and Surgeons in New York City, “Based on these results, it’s likely there’s probably a lot more undetected atrial fibrillation among seniors.”

In 2014, the same study author published a paper in Am J Med, discussing how atrial fibrillation increases one’s risk of stroke 5-fold.

What’s so significant about a study such as this is the following:  If cardiac patients on long term monitors run the risk of this deadly heart rhythm being missed, what about those of us who aren’t continually monitored?

What is Atrial Fibrillation?

Atrial Fibrillation (Afib) is a type of abnormal heart rhythm in which the electrical impulses fail to travel through the heart muscle rhythmically and predictably.  Since the heart muscle is a pump, it relies on methodical impulses so it can fill and pump the blood throughout the body properly.

Electrical impulses, in a healthy individual, originate in the SA (sinoatrial node) in the right atrium of the heart.  The SA node gauges the rate of the impulses based on the person’s activity.  Hence if one is exercising and needs more cardiac output, the SA node will trigger a faster pulse so oxygenated blood is delivered throughout the body quicker.

The electrical activity, once discharged, travels to both upper chambers of the heart (the atria) and then down to the AV node and then to the septum between both lower chambers of the heart (the ventricles).

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Image above from PinnacleHealth

 

The right ventricle pumps blood into the lungs to become oxygenated. This blood travels back to left atrium which pumps it into the left ventricle.  The left ventricle then pumps the blood into the aorta which transmits it to smaller vessels throughout the body.

As you can imagine, the pump and its electrical impulses need to work in concert.  In atrial fibrillation, however, the SA node isn’t in charge anymore and electrical impulses misfire throughout the atria.  This causes a “fibrillation” of the heart muscle where it loses its normal heart beat and beats erratically. The heart pump cannot fill adequately and blood starts to slosh around since its not being pumped out efficiently.

Blood that sits and sloshes around can form clots.  These clots can travel once they do finally exit the heart and block blood flow to the lungs (pulmonary embolus) or to the brain (stroke).

What are signs or symptoms of atrial fibrillation?

Patients can often go “in and out” of atrial fibrillation.  Many times they won’t notice it at all.  However symptomatic afib may cause the following:

Shortness of breath

Palpitations

Chest Pain

Dizziness

Fatigue

Cough

What are the risk factors for atrial fibrillation?

Although afib can occur at any age, it may become more common as we age.

Moreover those with high blood pressure, heart disease, sleep apnea, COPD, lung disease, diabetes and thyroid issues may be at higher risk as well.

Alcohol use in high quantities can increase one’s risk and energy drinks may trigger an abnormal heart rhythm as well.

How can I get screened for atrial fibrillation?

Firstly, you can discuss your risk factors with your medical provider.  Some insurance companies, however, may not always pay for screening.

Secondly, you can get screened and evaluated for stroke risk through Life Line Screening.  According to their website, they offer screening packages that not only test for atrial fibrillation but also evaluate for carotid artery disease (of which can also increase risk of stroke), abdominal aortic aneurysm, peripheral vascular disease, and osteoporosis.

 

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I just had my screening at Life Line and it was easy and painless. For me, I didn’t want to wait to have a heart condition before I wore a heart monitor.

The study above was presented in Barcelona, Spain, at the European Society of Cardiology’s annual meeting.

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician