Heart attack and strokes are common diseases in the community; But how much do we know about these diseases?
Cardiovascular diseases are the leading cause of death globally; People who die each year from cardiovascular disease are more likely to die from any other cause. In 2016, an estimated 17.9 million people died of cardiovascular disease. This is equivalent to 31% of all deaths that year. Of this amount, 85% were due to heart attack and stroke. More than three-quarters of deaths from cardiovascular disease occur in low- and middle-income countries. Of the 17 million untimely deaths (under the age of 70) due to non-communicable diseases in 2015, 82% occurred in low- and middle-income countries, and 37% were due to cardiovascular disease. According to the latest statistics published by the World Health Organization in 2017,
Most cardiovascular diseases can be prevented by modifying behavioral risk factors such as tobacco use, unhealthy diet and obesity, physical inactivity, and excessive alcohol consumption. People with cardiovascular disease or people who are at risk for these diseases need prompt diagnosis and management.
What is a heart attack?
Heart attack A heart attack occurs when blood flow to the heart stops due to a blood vessel blockage. This blockage is often caused by the accumulation of fat, cholesterol, and other substances that cause plaque to form in the arteries that feed the heart (coronary arteries). The plaque eventually breaks and forms a clot. Stopping the blood flow that nourishes the heart can cause damage or damage part of the heart muscle. A heart attack, also called a myocardial infarction, can be fatal in some cases, but its treatment has improved significantly in recent years. If you think you may have a heart attack, you should call the emergency medical center.
Symptoms of a heart attack
Common signs and symptoms of a heart attack include:
- Feeling of pressure, tightness, pain, or shooting in the chest or arms may extend to the neck, jaw, and back.
- Nausea, indigestion, heartburn, or abdominal pain
- Shortness of breath
- Cold sweat
- The feeling of lightheadedness or sudden dizziness
Symptoms of a heart attack vary
Not everyone who has a heart attack has the same symptoms or the same severity of symptoms. Some people have little pain; Others may feel more pain. Some people have no symptoms, and for others, the first sign may be a sudden cardiac arrest. However, the more signs and symptoms a person has, the more likely they are to have a heart attack. Some heart attacks occur suddenly, but many people have warning signs and symptoms hours, days, or even weeks before a heart attack occurs. The first warning may be a feeling of pain or pressure in the chest area (angina) that intensifies with activity and subsides with rest. Angina is caused by a temporary decrease in the blood flow to the heart.
When to see a doctor?
In a heart attack, speed of action is critical; some wait a long time because they do not know these critical signs and symptoms.
If a person is suspected of having a heart attack, he should not hesitate. The emergency room must be called immediately. If a person does not have access to emergency services, they should go to the nearest hospital and drive if there is no way out. Because the problem can get worse, driving in such situations puts the person and others at risk. A person with a problem should use nitroglycerin as directed by their doctor. If recommended, the person should take aspirin. Taking aspirin during a heart attack can reduce the severity of heart damage by preventing blood clots. Aspirin interacts with some other medications and should only be taken if advised by a specialist.
What should you do if you come across someone who has had a heart attack?
If you see someone who is unconscious and believe they have a heart attack, call the emergency room first. Then check to see if the person is breathing and pulsating. Cardiopulmonary resuscitation should be performed only to maintain blood flow if the person is not breathing or their pulse is not detected. The person’s chest must be pressed at about 100 to 120 times per minute to do this. If a person is trained in this area, he can help the patient through the respiratory tract.
Causes of a heart attack
A heart attack occurs when one or more of the coronary arteries (the arteries that carry blood to the heart muscle) become blocked. Over time, due to the accumulation of various substances, including cholesterol, the artery may narrow (atherosclerosis). This condition, known as coronary artery disease, is the cause of most heart attacks. During a heart attack, one of the artery wall plaques may rupture, and cholesterol and other substances may enter the bloodstream. A blood clot forms at the site of the plaque rupture, and if it is large enough, it can block blood from flowing through the coronary arteries and prevent oxygen and nutrients from reaching the heart muscle (ischemia). The affected person may have complete or partial blockage of the artery. The stages of diagnosis and treatment of these two conditions can be different. Another cause of a heart attack is a coronary artery spasm that blocks blood flow to a part of the heart muscle. Tobacco use and drugs, such as cocaine, can lead to fatal spasms.
Risk factors for heart attack
Known factors play a role in the unwanted accumulation of fatty deposits in the arteries, and most of these factors can be corrected.
Age: Men 45 and older and women 55 and older are more likely to have a heart attack than younger men and women.
Tobacco: This includes smoking and prolonged exposure to secondhand smoke.
High blood pressure: Over time, high blood pressure can damage the arteries that feed the heart. High blood pressure, which is associated with other problems such as obesity, high cholesterol, or diabetes, increases heart attack risk.
High levels of cholesterol and triglycerides in the blood: High levels of bad cholesterol (low-density lipoproteins) can cause the narrowing of the arteries. High levels of triglycerides (a type of blood fat associated with diet) also increase heart attack risk. However, high levels of optimal cholesterol (high-density lipoprotein) reduce the risk of a heart attack.
Obesity: Obesity is associated with high cholesterol levels, high triglycerides, high blood pressure, and diabetes. However, losing only 10% of your body weight can reduce this risk.
Diabetes: Failure to produce enough insulin (a hormone secreted by the pancreas) or lack of a proper response to it raises blood sugar, which increases the risk of a heart attack. (Diabetes: Everything About The Symptoms And Treatment Of Diabetes)
Metabolic Syndrome: This occurs when a person is obese, has high blood pressure and high blood sugar. Having metabolic syndrome doubles a person’s risk of heart disease.
Family history: If a person has a sibling, parent, or grandparent who has had a heart attack (up to 55 for male relatives and up to 65 for female relatives), he or she is also at risk.
Physical inactivity: Inactivity increases blood cholesterol levels and obesity. People who exercise regularly have better cardiovascular status, such as lower blood pressure.
Stress: A person’s response to stress may be in a way that puts them at risk for a heart attack.
Drug use: The use of stimulant drugs such as cocaine or amphetamines can cause coronary artery spasm and, eventually, a heart attack.
History of pre-eclampsia: This condition, which causes high blood pressure during pregnancy, increases heart disease risk throughout life.
Autoimmune diseases: Diseases such as rheumatoid arthritis or lupus can increase the risk of a heart attack.
Side effects of a heart attack
Complications are often caused by damage to the heart during a heart attack, which can lead to the following:
Arrhythmia (abnormal heart rhythm): Impaired electrical conduction of the heart can lead to abnormal heart rhythms, which in some cases can be severe and even fatal.
Heart failure: A heart attack can sometimes damage the heart tissue so much that the heart’s remaining muscle cannot pump enough blood out of the heart. Heart failure may be temporary or become a chronic problem due to permanent and extensive heart damage.
Sudden cardiac arrest: Sometimes, without warning, the heart may stop working due to an electrical disturbance that causes an arrhythmia. Heart attacks increase the risk of sudden cardiac arrest; A problem that can lead to death without immediate treatment.
A medical diagnosis of a heart attack
Ideally, your doctor should look for risk factors that could have caused a heart attack during a routine physical exam. The person is asked about the disease symptoms, and their blood pressure, pulse, and body temperature are checked. Experiments performed in this field are:
Electrocardiogram: This is the first test to diagnose a heart attack that records the heart’s electrical activity through electrodes placed on a patient’s skin. Because the damaged heart muscle cannot typically conduct electrical waves, the patient’s ECG can indicate a heart attack.
Blood tests: After a heart attack damages the heart, specific heart proteins enter the bloodstream. The doctor will examine a sample of the patient’s blood to check for these enzymes.
Chest Imaging Using X-ray: By examining this image, the doctor can determine the lungs’ heart and blood vessels’ size and fluid presence.
Echocardiogram: In this method, a moving image of the heart is prepared with the help of sound waves. If an area of the heart is damaged and cannot pump blood properly, it can be detected with an echocardiogram.
Angiography: A colored fluid is injected into the arteries of the heart. This pigment makes the arteries visible using X-rays, and if areas are blocked, it will be identified.
Exercise Test: Within a few days or weeks after a heart attack, a person may take an exercise test to determine how their heart and blood vessels respond to pressure. This test may be fixed while walking on a treadmill or bicycle. Another method is an intravenous injection of a drug that stimulates the heart. The patient’s heart activity is then monitored.
CT scan or MRI: These tests can be used to diagnose heart problems, including the extent of damage to the heart from a heart attack. In a CT scan, a person lies on a table and enters a ring-like device. An X-ray tube circulates inside the device around the patient’s body, collecting images of his heart and chest. A person lies on a cardiac MRI desk and enters a tubular device that produces a magnetic field.
Heart attack prevention
It is never too late to prevent a heart attack; Even if the person has already had a heart attack. There are ways to prevent a heart attack:
Medication: Taking certain medications can reduce the risk of another heart attack and improve the damaged heart’s functioning. Medications prescribed by a physician should be taken regularly, and a physician should monitor the patient.
Lifestyle factors: Maintaining a healthy weight with a heart-healthy diet, non-smoking, regular exercise, stress management, and controlling conditions can lead to heart attacks such as high blood pressure, high cholesterol, and diabetes. (Diabetes: From The Symptoms To The Treatment)
A stroke occurs when the blood supply to a part of the brain is disrupted, and the brain tissue is deprived of oxygen and nutrients. Within minutes, brain cells begin to die. A stroke is an emergency, and immediate treatment is vital. Proper and timely initial action can reduce brain damage and subsequent problems. Unfortunately, the current state of stroke in the world is like an epidemic. One in six people worldwide suffers a stroke during their lifetime. Every year, 15 million people worldwide suffer a stroke, and 8.5 million people die as a result. Without proper action, this upward trend will continue. Stroke is the second leading cause of death in people over 60 years of age and the fifth leading cause of death in people aged 15 to 59. This condition also affects children. Stroke causes more annual deaths than AIDS, tuberculosis, and malaria. Stroke is also a significant cause of long-term disability worldwide. It is now more prevalent among people living in developing countries. From 2000 to 2008, the overall prevalence of stroke in low- and middle-income countries increased by up to 20% compared to the prevalence in high-income countries. Today, 2 out of every three people who have a stroke live in developing countries.
Symptoms of a stroke
If a person thinks they have a stroke, they should look for signs and symptoms. The time of onset of these symptoms should also be considered. The duration of these symptoms affects the choice of treatment for the patient.
- Impaired speech and comprehension
- Paralysis or numbness of the face, arms, or legs: The patient may suddenly experience numbness, weakness, or paralysis of the face, arms, or legs. This problem usually occurs on one side of the body. One should try to raise both arms at the same time. If one of the arms starts to fall, he may have had a stroke. One side of the mouth may also sag when smiling.
- Vision problems in one or both eyes: A person may have blurred vision and diplopia.
- Headache: A sudden, severe headache accompanied by vomiting, dizziness, or altered consciousness may indicate that the person has had a stroke.
- Gait Disorder: A person may experience sudden dizziness, loss of balance, and staggering state.
When to see a doctor
If a person thinks they have stroke symptoms, they should see a doctor immediately or seek emergency help even if those symptoms fluctuate or disappear. If you come across someone who is at risk for a stroke, do these tests:
- Face: Ask the person to smile; Is one side of his face drooping?
- Arms: Ask the person to raise both arms; Does one of his arms fall? Can’t he raise one of his arms?
- Speech: Ask the person to repeat a simple phrase; Is it unusual for him to speak?
If you notice any of these symptoms, call the emergency room. Do not wait for the symptoms to go away. The longer a stroke is treated, the greater the risk of brain damage.
Types of strokes
A stroke can be caused by an obstruction of an artery (ischemic stroke) or a ruptured blood vessel (hemorrhagic stroke). Some people may experience only a temporary disruption of blood flow to the brain (transient ischemic attack or TIA) that does not cause permanent damage to the brain.
About 80% of strokes are ischemic. Ischemic strokes occur when the arteries that go to the brain become narrow or blocked, causing a severe blood flow reduction (ischemia). The most common ischemic strokes are:
Thrombotic stroke: A thrombotic stroke occurs when a blood clot forms in one of the arteries that carry blood to the brain. The clot may be caused by a buildup of fat accumulated in the arteries’ walls, reducing blood flow or other arterial problems.
Embolic stroke: An embolic stroke occurs when a blood clot forms outside the brain (usually in the heart) and travels through the bloodstream to the brain’s smaller arteries. This type of blood clot is called an embolus.
Hemorrhagic stroke occurs when a blood vessel in the brain leaks or ruptures. This condition can be caused by problems and diseases that affect the blood vessels, including:
- Uncontrolled hypertension
- Overdose with anticoagulants (blood thinners)
- Weaknesses in the walls of blood vessels (aneurysms)
- Another less common cause of cerebral hemorrhage is the rupture of a group of thin-walled blood vessels (cerebrovascular artery deformity).
Types of hemorrhagic strokes include:
Intracerebral hemorrhage (intracerebral hemorrhage): In an intracerebral hemorrhage, one of the blood vessels in the brain ruptures. The blood in it spills into the surrounding brain tissue, causing damage to brain cells. The blood cells around this rupture do not reach the bloodstream, and they are damaged. High blood pressure, trauma, vascular abnormalities, taking blood thinners, and other health problems can cause this type of cerebral hemorrhage.
Subarachnoid hemorrhage: In a subarachnoid hemorrhage, an artery near or near the brain’s surface ruptures, and its blood flows into the space between the brain and the skull. A sudden and severe headache often accompanies this bleeding. The rupture of a sac-like aneurysm usually causes subarachnoid hemorrhage. After bleeding, the brain’s blood vessels may become spasmodic, causing more damage to the brain by restricting blood flow.
Transient ischemic attack
A transient ischemic attack (TIA), sometimes referred to as a mild stroke, is a temporary period of symptoms such as a stroke. A temporary reduction in blood flow to a part of the brain causes TIA, which can last for just 5 minutes, for example. Like an ischemic stroke, a TIA occurs when a clot or other lesion prevents blood from reaching a part of a person’s nervous system; But in this case, there will be no permanent damage to the tissue and permanent symptoms.
Of course, even if the person’s symptoms appear to be gone, he or she should seek medical attention. Having a TIA puts a person at greater risk for a complete stroke. If a person has a TIA, it means that one of the arteries that carry blood to the brain is probably partially blocked or narrowed or that there is a source of a clot in the heart. It should be noted that it is impossible to determine based on symptoms only whether a person has had a complete stroke or a TIA. Even if the symptoms last for less than an hour, there is still a risk of permanent brain tissue damage.
Risk factors for stroke
Many factors can increase the risk of stroke. Some of these factors can also increase the risk of a heart attack. Possible treatable factors include:
Lifestyle risk factors
- Physical immobility
- Consumption of alcoholic beverages
- Use of drugs such as cocaine and methamphetamines
- Smoking or constant exposure to secondhand smoke
Medical risk factors
- Blood pressure above 120/80
- High cholesterol
- Obstructive sleep apnea
- Cardiovascular diseases including heart failure, heart defects, heart infection, or abnormal heart rhythm
- Family history of stroke, heart attack, or transient ischemic attack
Other factors associated with an increased risk of stroke include:
- Age: People 55 years of age or older are more likely to have a stroke than younger people.
- Gender: Men are more likely to have a stroke than women. Women are usually older when they have a stroke and are more likely to die from a stroke than men.
- Hormones: The use of birth control pills or hormone therapies that contain estrogen and an increase in estrogen levels due to pregnancy and childbirth.
Side effects of stroke
A stroke can cause temporary or permanent disabilities, depending on how long the brain has been without blood and which part of the brain has been affected. Side effects may include:
Paralysis or loss of muscle movement: A person may become paralyzed on one side of the body or lose control of specific muscles, such as those on one side of the face or arm. Rehabilitation therapies help the patient resume activities such as walking, eating, and the dressing that have been disrupted by the illness.
Impaired speech or swallowing: A stroke may affect the control of the mouth and throat muscles, making it difficult for a person to speak or swallow. Speech comprehension, reading, or writing may also be impaired. In this case, referring to a speech therapist can be helpful.
Memory loss and difficulty thinking: Many people who have a stroke experience some degree of memory loss. Some may have difficulty thinking, judging, responding, and understanding concepts.
Emotional problems: People who have had a stroke may have difficulty controlling their emotions or may be depressed.
Pain: Pain, numbness, or other unusual sensations may be seen in parts of the body affected by the stroke. For example, if a stroke causes numbness in a person’s left arm, he or she may experience an annoying tingling sensation in that arm. People may also be sensitive to temperature changes, especially severe cold, after a stroke. This condition is known as central pain syndrome. This condition occurs within a few weeks of having a stroke and may progress over time. Because pain is due to a brain problem and not a physical injury, there are few treatments.
Changes in behavior and ability to take care of themselves: People who have a stroke may become isolated and irritable. They may also need help with their cleaning and daily chores.
Like other brain injuries, the success rate of treating these problems varies from person to person.
A medical diagnosis of stroke
To determine the most appropriate treatment for a person with a stroke, the medical team must determine the type of stroke and the affected brain areas. It is also necessary to check for other causes, such as a brain tumor or a drug reaction. The following tests are used to determine a patient’s risk of stroke:
Physical examination: The doctor asks the patient or his companion about the symptoms, when they started, and what they were doing when the symptoms occurred. The doctor will also ask about the patient’s medication and a history of head injuries. It will also ask about a person’s family history of heart disease, transient ischemic attack, and stroke. The doctor will then measure the patient’s blood pressure and use a medical earphone to listen to their heartbeat. The doctor may also examine the patient’s eyes for small cholesterol crystals or clots in the veins behind the eye.
Blood tests: The patient may have several blood tests for blood clotting rate, blood sugar, essential blood components, and infection.
CT scan: The CT scan uses X-rays to create an accurate image of the brain. A CT scan can show bleeding, stroke, and other brain problems. Doctors may insert a pigment into the patient’s bloodstream to see the blood vessels in the neck and brain in more detail.
MRI: MRI uses radio and magnetic waves to create an accurate image of the brain. An MRI can detect brain damage due to ischemic stroke and cerebral hemorrhage.
Carotid ultrasound or ultrasound: In this test, accurate sound images are taken from inside a carotid artery in the patient’s neck using sound waves. This test can show fat plaques and blood flow in the carotid arteries.
Cerebral angiography: In this test, the doctor guides a thin, flexible tube (catheter) through a small incision, usually made in the groin, to the main arteries. The doctor then injects a dye into the patient’s blood vessels so that the vessels can be seen under X-rays. This process provides an accurate picture of the arteries in the brain and neck.
Echocardiogram: This technique uses sound waves to create an accurate image of the heart. An echocardiogram can find the source of a blood clot in the heart that may have traveled from the heart to the brain and caused a stroke.
Prevention of stroke
Awareness of risk factors, following your doctor’s advice, and living a healthy lifestyle are essential steps to prevent stroke. Many stroke prevention strategies are similar to those of heart disease prevention strategies. In general, healthy lifestyle recommendations in this area include:
Controlling high blood pressure: This is one of the most important things to consider to reduce stroke risk. If a person has had a stroke, lowering blood pressure can help prevent the next stroke. Exercise, stress management, maintaining a healthy weight, and reducing sodium and alcohol intake can help control blood pressure. In addition to lifestyle changes, your doctor may prescribe medications to control your blood pressure. (Hypertension: Symptoms, Prevention, And Treatment)
Reduce cholesterol and saturated fats in the diet: Consuming lower amounts of cholesterol and fats, especially saturated fats and trans fats, can reduce plaque formation in the arteries. If you can’t control your blood cholesterol levels just by managing your diet, you may need to take cholesterol-lowering drugs.
Quitting smoking: Smoking increases the risk of stroke in smokers and non-smokers exposed to secondhand smoke. Quitting smoking reduces a person’s risk of stroke.
Diabetes control: A person with diabetes can manage their disease with proper diet, exercise, weight control, and medication.
Maintaining a healthy weight: Being overweight helps with stroke risk factors such as high blood pressure, cardiovascular disease, and diabetes. Weight loss of up to 5 kg can also lower blood pressure and improve cholesterol levels.
Eating a diet high in fruits and vegetables: Eating five fruits and vegetables a day can reduce your stroke risk. It can also help follow Mediterranean diets that emphasize the consumption of olive oil, nuts, vegetables, and whole grains.
Regular exercise: Aerobic exercise reduces the risk of stroke. Exercise can lower blood pressure, increase high-density lipoproteins, and improve blood vessels’ general health and the heart.
Avoid alcohol: Drinking too much alcohol increases the risk of high blood pressure, ischemic stroke, and hemorrhagic stroke.
Treatment of Obstructive Sleep Apnea: This is a condition in which the body’s oxygen levels drop intermittently overnight. Treatment includes oxygenating the patient overnight or using a small device in the mouth to help breath.
Avoid drugs: Drugs such as codeine and methamphetamines are risk factors for stroke. Cocaine reduces blood flow and narrows the arteries.
Stroke prevention drugs
If a person has a stroke or TIA, your doctor may prescribe medications to reduce another stroke risk. These medications include the following:
Antiplatelet drugs: Platelets are a type of blood cell involved in the formation of blood clots. Antiplatelet drugs reduce the adhesion of these cells and reduce the chance of clots forming. The most common antiplatelet drug is aspirin. The doctor will prescribe the appropriate amount of this medicine for the patient. Your doctor may also prescribe Aggrenox, a combination of low-dose aspirin and the antiplatelet drug dipyridamole, to reduce the risk of blood clots. If aspirin cannot prevent TIA or stroke, or if a person cannot take aspirin, your doctor may prescribe another anticoagulant such as clopidogrel.
Anticoagulants: These drugs, which include heparin and warfarin, reduce the formation of blood clots. Heparin is faster and may be used in the hospital for a short time. Warfarin, which has a slower rate of action, may be used for more extended periods. Warfarin is a potent blood thinner, so it is essential to take it exactly as your doctor advised and consider its side effects. Your doctor may prescribe these medications if you have certain blood clotting disorders, arterial abnormalities, abnormal heart rhythms, or other heart problems. If your stroke or TIA is due to an abnormal heart rhythm, your doctor may use newer blood thinners.