CEREBRAL AND CARDIOVASCULAR RISK &

IDENTIFICATION

LARRY WILSON, MD, FACEP

Stroke Risk & Identification

Stroke in perspective 3rd leading cause of death Leading cause of serious long term

disability in the U. S. Women more likely to die from a stroke

than men On average, every 40 seconds someone

has a stroke

What a Stroke? Death of brain cells leading to loss of

neurological function Two types

Ischemic Stroke: blocked circulation to a part of the brain usually due a blood clot, often in a narrowed artery

Hemorrhagic Stroke: ruptured blood vessel, usually arterial, causing circulation loss to part of the brain

87% if strokes are ischemic and 13% hemorrhagic

Transient Ischemic Attack (TIA) Temporary neurological symptoms in the

distribution of a blood vessel that blocks, and then clears

Usually develop stroke like symptoms that resolve in 60 minutes or less

Similar to Angina preceding a heart attack

Stroke Symptoms F.A.S.T. Face: facial droop on one side: ask the

person to smile Arms: Loss of coordination or

weakness/numbness on one side- hold both arms straight out from the body- does one drift downward?

Speech: Ask the person to repeat a simple sentence- was it repeated normally?

Time: Get to the Hospital immediately if any of the above are abnormal: Time is Brain

Stroke Symptoms Less common, but potentially stoke

symptoms: New type of severe headache Sudden Nausea/Vomiting Sudden sleepiness or agitation Ataxia- staggering while moving, clumsiness

Stroke Risk Factors Blood pressure: increased risk for blood pressure

above 120/80 Cholesterol: Should be less than 200 mg/dl Diabetes Smoking Diet: know your Body Mass Index- BMI less than 24 Exercise: cardiovascular fitness reduces stroke risk Family History: Increased risk if immediate family

members with heart or cerebral vascular disease at an early age.

Reducing the Risk of Stroke

Check blood pressure and work with a doctor to achieve BP less than 120/80

Have your cholesterol checked and work on reduction if elevated

Check for diabetes If a smoker, work on smoking cessation Drink alcohol in moderation

Reducing the Risk of Stroke

Have an ECG or heart rhythm evaluation to check for Atrial Fibrillation

Develop an exercise habit Enjoy a reduced fat and sodium diet

Medication that may Help Manage Risk

Antihypertensives- reduce blood pressure Antidysrhythmics- control Atrial

Fibrillation Anticoagulants- decrease clotting risk Anticholesterol/lipid medications Diabetic medications

What is Heart Disease?

Prevalence of Heart Disease

Affects 25% of the US population. Each year: Claims 1 million lives Cost $290 billion

Heart Disease in the U.S.2004- 1 of every 5 deathsEvery 26 seconds someone suffers a heart attackEvery 1 minute someone will die from a heart attack

Warning Signs of a Heart Attack

Uncomfortable pressure, heaviness, squeezing or pain in the center of the chest lasting at least 2 minutes.

Pain the travels to the shoulders, arms, neck, jaw or back

Severe pain, lightheadedness, fainting, sweating, nausea or shortness of breath

Atypical Symptoms Women, diabetics, the elderly Unusual fatigue New, unusual shortness of breath with

everyday activity or while a rest Nausea or Dizziness Stomach or lower chest pain; back pain

If Symptoms Develop- Seek Immediate Care

Time is heart muscle Treating heart disease:

Medications Angioplasty and Stenting Bypass Implantable devices

Risk Factors Predict the Development of Heart

Disease

Non-modifiable Risk Factors

Age Race Gender Family History Diabetes

Modifiable Risk Factors Blood Pressure Cholesterol Smoking Diabetes Obesity Physical Fitness

Blood Pressure Rarely causes symptoms Strains Heart Muscle and increased heart

oxygen use Damages blood vessels

Blood Pressure Classification

Class SBP DSPNormal <120 <80Pre HTN 120-139 80-89Stage 1 140-159 90-99Stage 2 > 160 > 100

30% do not know that they have High Blood Pressure

Achieve Desirable Blood Pressure

Reduce weight Keep salt intake to less than a teaspoon

daily- both added and in foods Assure eating plenty of fruits and

vegetables; low-fat dairy products Exercise Reduce stress Medications

Diabetes Single greatest risk factor predicting

heart disease

Diabetes contributes to: High Blood Pressure High LDL cholesterol High Triglycerides Low HDL cholesterol Irritates blood vessel walls

Diabetes Risk of developing heart disease: Women: 5-7 times Men: 2-3 times

Lipids and Lipoprotiens Good: HDL Bad: LDL Ugly: VLDL

Cholesterol Levels HDL

Women- 60 mg/dl or higher Men- 50 mg/dl or higher

LDL Normal 90-100 mg/dl Desire < 100 mg/dl In heart disease or diabetics: goal < 70 mg/dl

VLDL- highest triglycerides Desire below 20 mg/dl

Obesity and Heart Disease Extra weight adds strain to the heart and

cardiovascular system Since 1991 obesity has increased 75% 7 of ten adults are overweight Body Mass Index: BMI

Exercise and Heart Disease Active persons reduce cardiovascular risk

by 50% Opportunity to Exercise: OTE

Walk stairs Park farther from store front or walk/bike to

store Take walk breaks during the day Partner up: walk/run/bike/gym

Exercise Improves blood lipid profile Burns calories and reduces weight Improves blood pressure Improves blood sugar control Decreases depressed moods Decreases stress Improves energy and confidence

Tobacco and Heart Disease Tobacco use increases the probability of

Heart Disease Nicotine:

Speeds development of atherosclerosis Decreases HDL cholesterol levels Binds carbon monoxide to Red Blood Cells,

decreasing oxygen delivery tissue

Influence of Diet Polyunsaturated fats and

Monounsaturated fats- healthiest Saturated fats- less good Trans fats- the worst

High fiber and low glycemic index

Fruits and Vegetables Whole grains Brans Unrefined cereals

Be Pro-Active Healthy Habits

Maintain healthy weight- BMI < 24. Physical activity Non-smoker Eating Habits:

Fruits and vegetables Low fat dairy Low total fat Avoid saturated and trans fats

Healthy Habits Low salt Control blood sugar Know your numbers

Blood Pressure Lipid Panel Blood Glucose

Tests for a Healthy HeartUnder 40:

Blood PressureLipid ProfileBlood Chemistry

Over Age 40:UrinalysisEKGStress Test

Proactive Care No your numbers

Seek treatment for BP, DM, cholesterol Eat right and get regular exercise Watch your weight Smoking cessation Recognize symptoms

Seek immediate care

Cerebral and Cardiovascular Care

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