cardiac
HEALTH ON TIME
TM
SUMMER 2013
take brain attacks to heart HEART HEALTH AND STROKE: WHAT’S THE CONNECTION?
S
trokes are often referred to as “brain attacks,” but did you know that many strokes originate in the heart? The American Heart Association estimates that 795,000 strokes occur annually in the United States, and an estimated 15–20 percent of those strokes are related to an untreated common heart condition known as atrial fibrillation (AF). AF occurs when the heart’s electrical signals are interrupted, creating a chaotic, disorganized rhythm in the upper chambers (atria), impairing their ability to “push” the blood through to the lower chambers (ventricles). The blood that is left behind can clot before it enters the bloodstream, increasing the risk for stroke. According to the National Stroke Association, AF is a major risk factor for stroke and it makes a person 5 times more likely to have a stroke. Strokes occur when a blood vessel that brings blood carrying oxygen and nutrients to the brain is
A stroke occurs every 40 seconds in the U.S., and 1 American dies from stroke every 4 minutes. clogged or bursts. When this happens, part of the brain doesn’t get the blood and oxygen it needs. When deprived of oxygen, nerve cells in the brain can’t work and begin to die within minutes. Depending on the part of the brain affected, speech and/or body movement will be impaired. Dead brain cells cannot be replaced, so the damage is permanent. However, through rehabilitation, full or partial recovery can sometimes be achieved. Strokes caused by AF are far more damaging than many other types of strokes. According to estimates from the American Heart Association, 15 to 20 percent of all strokes are caused by AF; strokes related to AF are often major events, causing significant
stroke alert! PREVENT CAROTID ARTERY DISEASE A stroke can change your life forever, especially if you don’t get fast, effective care. But the most common type of stroke is largely preventable. According to Gyanendra K. Sharma, M.D., a cardiologist with Georgia Regents Heart and Cardiovascular Services, stroke occurs when fatty deposits build up in the GRU-004
SMALL CLOT, BIG PROBLEM FROM THE HEART. . . Blood clots that form in the heart can travel to the brain to cause a stroke. Cardiovascular disease is the cause of most such clots, which form in the chambers or valves of the heart before entering the bloodstream. . . . TO THE BRAIN broken blood vessel Section of the brain showing the middle cerebral artery.
1
blood clot
2
CAUGHT UNAWARE? Ignorance is not bliss. A 2011 survey by the American Heart Association found that half of all adults living with atrial fibrillation did not know they were at higher risk for stroke. Other risk factors include high blood pressure (the single highest cause of stroke), diabetes, tobacco use (including second-hand smoke), and physical inactivity and obesity.
1 Hemorrhagic strokes are caused by a blood vessel breaking and leaking blood into or around the brain. Although less frequent than ischemic strokes, hemorrhagic strokes result in more deaths.
2 Ischemic strokes result from blood clots that interrupt the flow of blood to the brain. Eighty percent of strokes are ischemic.
disability or death. Additionally, strokes caused by AF result in significant neurological deficit. There is promising news for treatment. AF can be managed with medication and/or specialized cardiac procedures. Since high blood pressure is the No. 1 cause of stroke, blood pressure medication, in addition to lifestyle changes like exercise and quitting smoking, can lower stroke risk.
Protect your heart! To schedule an appointment with a cardiologist, call 706-721-2426. To schedule a $100 calcium screening, call 706-721-9729 or visit gru.edu/cardio.
carotid arteries, blocking blood flow to the brain. Carotid artery disease develops slowly, causing no symptoms in the early stages. The first sign may be a transient ischemic attack (TIA), also called a mini stroke, or even a full-blown stroke.
Lower your risk If you’ve had a TIA, tell your physician. Having had a TIA, aging and family history all increase your risk of stroke, as do: • high blood pressure • smoking • diabetes •b eing obese and inactive • high cholesterol “The more risk factors you have, the greater your risk,” Dr. Sharma says. “If you have any of these risks, speak to your physician. You many need a physical exam and imaging tests to determine if your carotid arteries are blocked.”
Stroke symptoms When the disease advances, you may experience sudden numbness or weakness in your face, arm or leg on one side of the
body; slurred or garbled speech; or sudden blindness. If these symptoms occur, seek immediate medical care, even if the symptoms go away. If taken within three hours of the onset of symptoms, a blood-thinning medication may restore blood flow to the brain.
Treatments Mild to moderate cases of carotid artery disease may respond to lifestyle changes and medications. If the blockage is severe or you’ve already suffered a TIA or stroke, surgery or stents can open the artery and increase blood flow to the brain.
For more information, please visit gru.edu/stroke. GRU-004
Georgia Regents University 1120 15th Street, AD 1114 Augusta, GA 30912
NONPROFIT U.S. POSTAGE PAID GEORGIA REGENTS UNIVERSITY
For additional graphics and KRT products, visit Presslink
http://online.presslink.com/new-cgi/waisgate/Providers/KRTgate.pl
.
Mini-stroke: A temporary ‘brain attack’
Transient ischemic attacks, or (TIAs), are “mini-strokes” that resemble strokes in many ways, but do not cause permanent damage. TIAs occur when blood clots travel into blood vessels in the neck or brain. 1
Its cause
2
Symptoms begin abruptly, peak rapidly
Brain tissue begins to die due to lack of blood supply.
Clot-Busting Drug Stops Stroke
brain
Brain
cerebral artery Cerebral Cerebral artery artery
Cerebral artery
brain
ORIGIN: KRT, San Jose Mercury News GRAPHIC SIZE: 3 col. x 3.5” POSTED: 11/4/99
cerebral artery
3 1
2
3
Clots can fully or partially block the carotid artery, hindering blood flow to the brain.
clot
occurs when a clot n in the brain; a Ischemic a clot strokeoccurs occurswhen when a clot 1 Ischemicstroke brin holds the clot blocks a a blocks circulation circulationininthe thebrain; brain;
protein clot protein called calledfibrin fibrinholds holdsthe the clot plasmin together together directly into the vein, TPA intothe ach involves directly vein, injecteddirectly directlyinto the vein, 2 TPA isis injected to the carotid artery or aa new directly newapproach approachinvolves involves directly
injecting artery injecting TPA TPAinto intothe thecarotid carotid artery hen plasmin breaks in clot Clot dissolves dissolveswhen whenplasmin plasminbreaks breaks 3 Clot up fibrin fibrinstrands strandsininclot clot
clot TOO LITTLE, TOO LATE
plasmin TPA
Can happen again
Clot breaks up or moves, allowing blood to flow again to brain Symptoms fade away within 30 minutes
If mini-stroke recurs, symptoms may be different because location of blockage is a matter of chance and may not occur in the same place twice About 15 percent of all strokes are preceded by a mini-stroke
SURGICAL OPTIONS STENT
known as carotid endarterectomy is the standard treatment to prevent stroke from occurring or recurring. During the procedure, vascular surgeons open the blocked blood vessel and physically remove deposits of plaque. 790 NATIONAL PRESS BUILDING, WASHINGTON, D.C. 20045 According to the©National Institute of Neurological Copyright 1999 Knight Ridder Tribune, Inc. Reprint with permission onl e-mail: graphics@krtinfo.com The and credit Stroke “Knight Ridder Tribune”the or “KRT” must appear with all uses of this graphic imag Disorders (NINDS), surgery reduces risk of stroke by more than 80 percent in people who have a significant blockage in the artery and have had a stroke, or stroke symptoms.
(202) 383-6064
According to the American Heart Association, only onethird of stroke victims arrive at the hospital in time to benefit from TPA treatment.
the benefits of Georgia Regents Comprehensive Stroke Center
Too Little Too Late
act FAST for stroke
According to the Journal Too Little Too Late of the American Medical According Accordingto tothe theJournal Journal Association, fewer than edical School Family Health Guide, New England Journal of Medicine of the the American AmericanMedical Medical e Philadelphia Inquirer © 2002 KRT 5 percent of stroke victims Association, fewer Association, fewerthan than Use this handy acronym to recognize the signs of in stroke and get Source: Harvard Medical Guide, England Journal of Source: Genentech, Genentech, Harvard Medical School School Family Family Health Health Guide, New New England Journal of Medicine Medicine arrive at the hospital Graphic: © Graphic: Aaron Aaron Steckelberg, Steckelberg, The Philadelphia Inquirer Inquirer © 2002 2002 KRT KRT 5 percent percentofofstroke strokevictims victims help fast The Philadelphia time to benefit from T-PA arrive at atthe thehospital hospitalinin treatment. time time to tobenefit benefitfrom fromT-PA T-PA F Face drooping: Does the victim have facial numbness, or treatment. treatment.
does one side of the face droop? Ask them to smile—is their smile uneven? A Arm weakness: Ask the person to raise both arms. Is one arm weak or numb, or does one arm drift downward? S Speech difficulty: Is the person’s speech slurred, or are they difficult to understand? Ask them to repeat a simple sentence; can they repeat it correctly? T Time to call 911: If a person shows any of these symptoms, call 911. Don’t wait—even if the symptoms go away, get help.
2nd time
neck, clot, thrombus, phlebitis, vein, leg, symptom, onset, cause, weakness, speech, aphasia, repeat, second, risk, mccomas, GOLD STANDARD krt, 1999, risk, women, black, african, A surgical procedure american, african-american
clot 2
4
Stenting reduces the risk of complications from carotid angioplasty, a minimally invasive procedure meant to repair blocked arteries. While angioplasty can successfully restore blood flow San Jose Mercury News, KRT SOURCE: Magee Rehabilitation Hospital (Philadelphia) through the carotid artery, there is a risk that small bits of 1/4/99 plaque or clots will develop during the procedure and cause a stroke. This procedure employs a tiny umbrella-like membrane to catch and remove loose pieces of plaque before they can reach the brain. The umbrella is removed after the procedure, while the stent remains in the artery to help keep it open. FILE INFORMATION KEYWORDS RELATED KRT PRODUCTS AND STORIES is recommended for patients considered atESTROGEN, high CATEGORY: HEALTH With 19980702 STROKE TREATMENT, 19980806 STROKE AND health, medicine, national, world, science, Stenting FILE NAME: Mini stroke.fh8 19980922 CAROTID AND STROKE, 19990223 FRUIT AND VEGETABLES, stroke, mini, ministroke, mini-stroke, risk for traditional carotid endarterectomy surgery due to age ILLUSTRATOR: H. McComas KRT News In Motion animations transient, ischemic, brain, attack, blood, RESEARCHER: H. McComas supply, block, obstruct, artery, carotid, head, or health status.
Embolism (blood clot)
Brain
How it ends
SYMPTOMS VARY Most Common: Blurred or double vision Also: Hand or arm numbness, weakness; difficulty speaking or understanding speech
Deep vein thrombosis can occur in younger patients when the clot enters in the left side of the heart or through an opening in the atrial septum
TPA: EVERY SECOND COUNTS
3
Clot partly or fully blocks carotid artery in neck or one of its branches to the brain
Clot breaks loose usually from the carotid artery or heart
• Brain cells no longer receive oxygen or nutrients and begin to die.
The “clot-busting” drug TPA, if administered promptly, clot significantly increases the chance that a person who has suffered the most common kind 1 of stroke will be able to live a normal life afterward.
How it begins
1st time
• The blood supply to the brain is interrupted due to a blood clot or embolism OR a blood vessel in the brain ruptures.
• Stroke research concentrates on increasing the “available window” when damaged brain cells may be revived.
http://www.krtdirect.com/weatherquiz
WHAT IS A MINI-STROKE? A sudden “mini-stroke” occurs when a blood clot briefly blocks an artery supplying blood to the brain.
ANATOMY OF A STROKE
• Some brain cells are damaged but survive. If blood flow is restored in time, some of these cells may function again.
Check out new premium Web feature “WeatherQuiz”
NOTE: This graphic may be of interest to readers whom newspapers are “at-risk” of losing (women, African Americans, HIspanics or young readers)
Every 40 seconds, someone in the United States suffers a stroke. Every three to four minutes, someone dies from a stroke. Each year stroke affects more than 795,000 Americans, killing more than 140,000 and leaving thousands of others disabled. Worldwide, stroke ranks second only to heart disease as a cause of death. Yet, in many ways it remains a silent epidemic. Studies show that Americans are less aware of stroke risks than of heart or cancer risks. In a recent survey, 7 out of 10 women said they are not aware they are more likely than men to have a stroke, and were not at all or only somewhat knowledgeable about risk factors. And only 27 percent of women could name more than two of the primary stroke symptoms. Because the symptoms can be temporary and painless, people may ignore stroke-like symptoms, or mini-strokes. According to the American Heart Association, the number of stroke patients will increase by 21.9 percent from 2013 to 2030, but few recognize that many strokes could be prevented using current lifestyle changes and medical techniques available today. There have been positive advances. Surgery can restore blood flow through blocked arteries. Newer medications can stop bleeding and save brain function. Ongoing research is expanding the window of opportunity for treating stroke without devastating loss of brain function. Yet a major goal remains: to convince people to treat stroke with the seriousness this silent epidemic deserves, to recognize stroke symptoms in time to take action, and to adopt healthier habits to reduce their personal risk factors.
ug TPA, ptly, s the who t ke
http://www.krtdirect.com/
brain attack
running out of time?
ug
and KRT Direct
The Comprehensive Stroke Center is the only one in the area offering: • the latest generation angiography technology. It images the entire clot in patients with ischemic stroke. • clot retrieval to physically remove clots • intra-arterial tissue plasminogen activator (tPA). This clotbusting drug can be administered directly onto the clot.
The neck just below the ear is a common endarterectomy site.
• at least one neurologist and neurosurgeon 24/7, something you are likely to find only at an academic health center If you or someone in your family experiences stroke symptoms, call 911 immediately and request Georgia Regents Comprehensive Stroke Center. For more information, please visit gru.edu/stroke.
YOUR HEART HEALTH LIFELINE
0-25 YEARS
25-40 YEARS
Get plenty of exercise and eat right. Obesity rates and resulting high blood pressure are on the rise in young folks.
Check food labels. What you eat affects your chances of getting high blood pressure. Eat foods that are low in saturated fat, total fat, and cholesterol. Don’t overdo the alcohol. Drinking too much alcohol can raise blood pressure. If you drink, do so moderately—one drink a day for women, two drinks a day for men.
Easy on the caffeine. Cut back on caffeine intake if you are at risk for developing high blood pressure.
DIABETES
40-55 YEARS Watch your weight. Being overweight or obese increases your risk for developing high blood pressure. If you are overweight, losing even 10 pounds can lower your blood pressure.
55-75 YEARS Watch your blood pressure. For people ages 50 and older, systolic pressure (the top number on your reading) gives the most accurate diagnosis of high blood pressure.
Reduce sodium. Using less sodium keeps blood pressure at healthy levels.
75+ YEARS Stay physical. Combine everyday chores with moderate- level activities, like walking or swimming.
Check over-the-counter drugs. Some drugs, including dietary and herbal supplements, can raise blood pressure.
Take prescribed drugs as directed by your physician. Watch out for possible drug interactions if you’re taking more than one medicine.
blood sugar screening every 3 years after age 45
BLOOD PRESSURE screening annually CHOLESTEROL screening every 5 years
more often for men over 50, women over 45, and anyone with other risk factors for heart disease or stroke
HEART DISEASE
56789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919 stroke risk zone OBESITY
People who have excess body fat—especially if a lot of it is in the waist area—are more likely to develop heart disease and stroke even if they have no other risk factors. Losing just 5 to 10 percent of your weight can help lower your heart disease risk.
For more information on our heart and vascular services, visit us online at www.gru.edu/cardio.
Spotlight on our heart and vascular team Dr. Preston Conger
Dr. Pascha Schafer
Dr. Henry Wiles
Director, Cardiac Rehabilitation Services
Associate Program Director for Cardiology Fellowship
Pediatric Cardiology
Dr. Preston is board-certified in internal medicine and cardiology. His clinical interests encompass echocardiography, heart failure management, valvular heart disease, hypertension, and preventive cardiology.
Dr. Schafer is board-certified in cardiology and echocardiography. She practices general non-invasive cardiology. Her clinical interests include cardiovascular disease.
Check out videos of our physicians and their heart-healthy tips at www.gru.edu/cardio.
Dr. Wiles is board-certified in pediatric cardiology. His clinical interests include non-invasive imaging, MRI, heart failure, cardiomyopathy, and transplantation.
FOR APPOINTMENTS, PLEASE CALL 706-721-2426.
Q&A Can my feet indicate that something’s wrong with my heart? Surprisingly, the answer is yes. If you have swollen legs or feet, that may be an indication of heart failure or, occasionally, of venous disease. If your heart is not strong enough to pump out all the blood it receives, blood flowing back to the heart could back up. Blood then pools in the leg veins, forcing fluids out of the veins and causing tissue to swell.
Feet don’t fail me now. What are your feet telling you about your heart?
BY THE NUMBERS What are the symptoms of high blood pressure?
120/70 normal 140/90 high DIASTOLIC Check it. The higher number of your blood pressure is the systolic pressure and it is the pressure of the blood flow when the heart beats. The lower number is the diastolic pressure and it measures the pressure between heartbeats.
breaking news
green tea and coffee? drink up!
A Japanese study, published by the American Heart Association journal Stroke in March 2013, reviewed the association of consumption of both green tea and coffee and its relation to a decreased risk of stroke in the general Japanese population. Green tea has been studied extensively for its antioxidant properties, and recent findings have shown coffee to be associated with reducing risk for diabetes and cancer. However, according to the study, little research has been done on the association of the combined use of both green tea and coffee consumption with the incidence of stroke. In the study, consumption of green tea and coffee were both shown to be beneficial for reducing all strokes and cardiovascular disease. Green tea contains catechins, which help to regulate blood pressure and have an antiinflammatory effect. The caffeine and compounds known as quinides in coffee influence heart health. So how much should you drink? The study noted benefits in subjects who drank four cups of green tea per day, and just one cup of coffee per day was found to decrease stroke risk by 20 percent.
let the sun shine Several U.S. studies in 2012 and a 2013 University of Edinburgh study have found a link between sun exposure and decreased incidence of stroke. The UK study found that 20 minutes of skin exposure to UV rays caused nitric oxide, a compound that helps lower blood pressure, to be released into a person’s blood vessels. A U.S. study presented at the American Stroke Association's International Stroke Conference in February 2012, reported that of the more than 16,000 black and Caucasian participants, those with less exposure to sunlight had a 56 percent increased risk of stroke, in part due to a reduced level of vitamin D. Of course, too much sun presents a risk of skin cancer and other health threats, like heat stroke and dehydration, but these studies suggest that sensible sun exposure can have hearthealthy benefits.
beat the clock on stroke
G
eorgia Regents Comprehensive Stroke Center has recently earned two national honors.
The center was named to the Target: Stroke Honor Roll by the American Heart Association/ American Stroke Association for excellence in emergency stroke care. It is currently one of only about a dozen centers in Georgia to earn that distinction, identifying it as one of the fastest, most responsive stroke centers in the nation. The Comprehensive Stroke Center also earned the American Heart Association/ American Stroke Association’s Get with the Guidelines® Stroke Gold Plus Quality Achievement Award for the second consecutive year, indicating excellent compliance with stroke care guidelines. By delivering fast, effective care, the center is saving lives and preventing disabilities.
For more information, please visit gru.edu/stroke.
For more information on our heart and vascular services, visit us online at www.gru.edu/cardio.
Copyright © 2013 GLC, Northbrook, IL 60062 U.S.A. This publication is not meant to replace professional medical advice or service. Personal health problems should be brought to the attention of appropriate medical professionals.
High blood pressure is often called the “silent killer” because there are no symptoms. The only way to diagnose high blood pressure is to have it checked. Contrary to popular belief, a person with high blood pressure isn’t necessarily tense, nervous, or hyperactive. Although approximately 25 percent or nearly 76,000 adults in the U.S. have high blood pressure, nearly one-third of them don’t know it. Having your blood pressure checked is quick and painless—and the only way to know if you have high blood pressure.
SYSTOLIC