Stroke and the Heart Heart Failure Now
What is a stroke
A stroke occurs when the blood supply to part of your brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. Brain cells begin to die in minutes. A stroke is a medical emergency, and prompt treatment is crucial. Early action can reduce brain damage and other complications.
The effects of your stroke depend on the type of stroke, the part of the brain that was damaged and the amount of damage.
Caused when an artery in the brain breaks open. The interrupted blood flow causes damage to your brain. High blood pressure weakens arteries over time and is a major cause of hemorrhagic stroke.
Transient ischemic attack (TIA)
Caused by a small clot that briefly blocks an artery. It is sometimes called a mini-stroke or warning stroke. The TIA symptoms usually last less than an hour, and may only last a few minutes. TIAs are an important warning that a more serious stroke may occur soon.
Caused by a blockage or clot in a blood vessel in your brain. The blockage can be caused when a substance called plaque builds up on the inside wall of an artery.
Determining Stroke Risk in AFib Patients Using the CHADS Score
AFib occurs in about 300,000 patients in Canada, and usually it occurs among patients who are older. When you get up to age 80, it can be up to 10 to 15 percent of patients who have atrial fibrillation.
It is a condition when the atrium is actually contracting irregularly, and then it can go in a very fast heart rate. And sometimes it leads to patients having palpitations, shortness of breath, and dizziness, and sometimes chest discomfort as well.
It is also associated with an increased risk of having a stroke, up to about two to four times. So it’s important to actually have yourself evaluated when you have atrial fibrillation, to assess the need for controlling your symptoms, as well as reducing the risk of having a stroke.
Once you have atrial fibrillation your risk of having a stroke goes up by two to four times of the general population. We use a method called CHADS to assess patients for the risk of developing a stroke. CHADS stands for C-H-A-D-S, C stands for congestive heart failure. H stands for hypertension. A stands for age (more than 75). D stands for diabetes, and S stands for stroke, or a mini stroke called TIA.
The stroke risk actually does not change whether you have symptoms or not with your atrial fibrillation. It’s important that you’re evaluated by your family doctor or your cardiologist regarding this risk, because depending on the risk that you have, then we have to decide whether you need to be put on an anticoagulant.
For patients who need to take an anticoagulant, there are two types. One is Warfarin, which we’ve been using for many, many years. And then there are newer types of anticoagulants known as NOACs, otherwise known as novel oral anticoagulants.
When we take Warfarin, there are some challenges with regard to having to measure the blood levels quite frequently, and also there is potential drug interactions as well as interactions with food. And also there are some increased risk of bleeding, particularly inside the brain, or dying from bleeding as well.
Regarding the newer oral anticoagulants, they’re more effective and also have less chance of bleeding inside the brain, or dying from actually bleeding complications with these new medications. These medications can be taken once a day, or twice a day, and also do not have as many food interactions or other medication interactions as well.
However, these new medications are shorter in the half life, so it’s important not to miss any doses. It’s important to maintain a healthy lifestyle. It’s important to eat healthily, and also maintain a healthy weight.
If you don’t know what it is, you should talk to your family doctor or your allied health professionals, such as a dietitian, or an exercise expert. It’s also important to stop smoking and also drink very sparingly. For example, one drink a day is acceptable, two or more can be difficult, especially among patients who have atrial fibrillation.
If you’ve recently been diagnosed with having atrial fibrillation, it’s important that you talk to your family doctor, as well as your specialist, about your condition and how to treat it. And if you have any questions about blood thinners, again talk to your doctor as well as other allied health professionals, such as your pharmacist as well as nurse practitioners.
Presenter: Dr. Chi-Ming Chow, Cardiologist, Toronto, ON
Local Practitioners: Cardiologist
Healthy living, diet and exercise.
Often people with atrial fibrillation want to know: can they lead a normal life and what does that entail? Is their life over, the way they know it? And really it’s actually the opposite, we encourage people to carry on with their usual activities. We want people to stay active and do the things that they enjoy. And the goals of management are to actually promote ongoing quality of life and symptom management.
People often ask: what does it mean to live well with atrial fibrillation? They have this new diagnosis, it’s very scary, they have these new symptoms, and really what it means is ensuring people are carrying on with lifestyle modifications that include diet, exercise, keeping a healthy weight, reducing things like alcohol, smoking cessation, all things that compound to influence other chronic conditions like high blood pressure or diabetes for example.
Which actually are causes for atrial fibrillation. Often atrial fibrillation is a symptom of other chronic conditions, so if we can keep those other chronic conditions under good control, then we can often keep the atrial fibrillation under good control with less episodes, better symptom management and less overall what we call atrial fibrillation burden. And so by modifying our lifestyle with good habits of dietary, exercising, and a good body weight, we can often keep these things under control.
Some people often underestimate the value of an exercise program, because they feel that maybe their exercise capacity is reduced, or they’re just out of shape, but actually it does take time to build this up. And there have been studies that have shown if people go through a boot camp with rigorous exercise, a strict diet with weight loss, that actually they had reduced burden of atrial fibrillation, reduced frequency of episodes, and they tolerated the symptoms when they did have episodes.
And it actually is something that they have control over, so often the atrial fibrillation, it’s being a new diagnosis for people. It’s their heart and it’s scary, and people feel vulnerable, and at a loss for control in some instances. They don’t like to take the medications that are offered to them, because it’s all new, and they have side effects sometimes and so they feel a loss of control.
But this is actually something where they do have a great deal of control and can take charge in a part of their life that actually really has good effects on managing their atrial fibrillation as proven now in studies. Even yoga has been proven to reduce the burden of atrial fibrillation, reduce heart rate and anxiety, which can all play a role in atrial fibrillation.
People with atrial fibrillation often want to know: when do I go to seek medical attention? And the reality – and the good news – about atrial fibrillation is it isn’t imminently life threatening, so it’s not going to cause the heart to stop or lead to a heart attack. But certainly people can feel very unwell with it.
If someone’s having an episode of atrial fibrillation and they’re feeling okay, they’re not overly unwell, it’s very safe to wait it out at home. If 12 to 24 hours have passed and symptoms are still ongoing, that would be the time to contact their health care provider for further direction.
If anyone is ever profoundly unwell with chest pain, shortness of breath, feeling like they’re going to faint, that’s definitely the time to be either calling 911 or going to seek medical attention, probably at their local emergency department.
Often people with atrial fibrillation feel a sense of loss of control because of the new diagnosis, medications that they’re not used to, symptoms that they’re not used to. But where they can gain control is with remembering that they actually have a great deal of influence on their condition by maintaining healthy lifestyle choices with diet, exercise and maintaining healthy body weight, reducing alcohol and smoking cessation.
So for any of those things if they need more assistance they can seek more information through their health care provider.
Dr. Dean Johnston, MD, MHSc, FRCPC, Neurologist, discusses How to Prevent a Stroke from Happening to You.
Dr. Ratika Parkash, MD, FRCPC, Cardiologist, discusses how stroke prevention with anticoagulant treatment is important in atrial fibrillation patients.