Stopping Killers in their Tracks (Part Three)
By Vicky L. Chappell, M.D., Texoma Cardiovascular Surgeons, Texoma LIVING WELL Magazine
As mentioned in previous issues, the top three leading causes of death are heart disease, cancer and stroke. The third leading cause of death, stroke, affects approximately 795,000 people each year. Stroke accounted for about one of every 17 deaths in the U.S. in 2006. In addition, it is the leading cause of serious, long-term disability in the U.S. Americans paid about $73.7 billion in 2010 for stroke-related medical costs and disability.
The risk of stroke increases with age. Most strokes occur in people over the age of 65; and the risk doubles each decade after the age of 55. However, strokes can and do occur at any age. Other risk factors include smoking, diabetes, elevated cholesterol, hypertension and cardiac arrhythmias.
There are different types of stroke. Ischemic stroke occurs as a result of an obstruction within a blood vessel supplying blood to the brain. It accounts for 87% of all stroke cases. Hemorrhagic stroke occurs when a weakened blood vessel ruptures. A transient ischemic attack (TIA) is caused by a temporary clot. Often called a “mini stroke,” these warning strokes should be taken very seriously.
The brain is an extremely complex organ that controls various body functions. The effects of a stroke depend on the location of the obstruction and the extent of brain tissue affected. Sudden presentation of any of the following signs may indicate stroke:
1. Numbness or weakness of the face, arm or leg, especially on one side of the body
2. Confusion or trouble speaking or understanding
3. Trouble seeing
4. Dizziness, loss of balance or coordination
5. Severe headache
Everyone should learn the warning signs of a stroke. Act FAST and call 9-1-1 immediately at any sign of a stroke. Use FAST to remember what to do:
FACE: Ask the person to smile. Does one side of the face droop?
ARMS: Ask the person to raise both arms. Does one arm drift downward?
SPEECH: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
TIME: If you observe any of these signs, call 9-1-1 immediately.
The goal is to get the stroke victim to a hospital as quickly as possible to determine whether thrombolytic or clot busting drugs can potentially reverse the stroke situation. There is a limited window of opportunity from the onset of symptoms to when this therapy can be used. If delays occur, the opportunity to intervene is lost. The most promising treatment for ischemic stroke is tissue plasminogen activator (tPA), which must be administered within three hours from the onset of symptoms to work best. Administering tPA or other clot-dissolving agents must be done through an intravenous line by hospital personnel. If given promptly, tPA can significantly reduce the effects of stroke. Unfortunately, only 3 to 5% of stroke patients reach the hospital in time to be considered for this treatment.
The best treatment for stroke is prevention. Up to 80% of strokes can be prevented, primarily through risk reduction. Seek evaluation by a health care professional routinely to control blood pressure, identify arrhythmias, and manage diabetes and cholesterol. If you smoke, stop. Smoking doubles the risk of stroke. It damages blood vessel walls and speeds up artery clogging. Control alcohol consumption. Alcohol use has been linked to stroke in many studies. Most doctors recommend not drinking or drinking only in moderation – no more than two drinks each day.
Fatty deposits can block arteries carrying blood to the brain and lead to a stroke. Carotid endarterectomy is a procedure in which a surgeon removes fatty deposits from the carotid arteries. While atherosclerosis and high cholesterol can often be managed with drug treatment, surgery is another option to help prevent stroke. Carotid endarterectomy can reduce stroke risk by as much as 55%. This is just one of the procedures routinely performed by the physicians at Texoma Cardiovascular Surgeons. We continue to work with primary care physicians and other consultants to decrease stroke deaths in our community.
- Barnett HJ, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. NEJM 1998;339(20): 1415–1425
- Goldstein LB, et al. Guidelines for the Primary Prevention of Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2011;42:517-584
To read Part One and Part Two of Dr. Chappell’s “Stopping Killers in Their Tracks,” visit www.LivingWellmag.com and enter keywords “Texoma Cardiovascular Surgeons.”
Author Vicky L. Chappell, M.D. is a physician with Texoma Cardiovascular Surgeons located in Sherman, TX and can be reached at 903-868-4595 or visit their website at www.TexomaHeartDoctors.com.