Abdominal Aortic Aneurysm (AAA)
An
abdominal aortic aneurysm is a weakness in the wall of the aorta in the abdomen
that allows the aorta to balloon out as the pressure from the passing blood
flow presses against it. The weakness is usually caused by the accumulation of
fat deposits, an injury or a defect that was present at birth.
In the
majority of cases, aneurysms grow gradually over a period of time, increasing
by an average of only two to three millimeters each year. It can take nearly 10
to 15 years for an aneurysm to reach a size at which surgery is deemed
necessary. At this time, the aneurysm measures 5-6 cm and is 1.5 times its
normal size. When the aneurysm reaches this size, the risk of rupture increases
by 20 percent per year and the one-year survival rate for patients without
surgery is estimated to be 50 percent.
In most
cases, a person with an abdominal aortic aneurysm has no symptoms until the
artery walls become severely dilated and the aneurysm has grown to a dangerous
size. At this time, a person may experience back pain. The first sign of
rupture is usually characterized by extreme pain in the lower abdomen and back.
The severe internal bleeding caused by a rupture is often fatal.
Abdominal
aortic aneurysms are the 13th leading cause of death in the Untied States,
accountable for the death of 15,000 Americans each year. Over the past 40
years, the prevalence of AAA has risen three-fold. Further, because people with
the condition are typically asymptomatic, it is estimated that only 200,000 of
the 1.5 million people with AAA are actually diagnosed.
Nearly 10
percent of all men over the age of 65 are likely to have some form of an
aneurysm. White males over 55 years of age are susceptible to AAAs. Rates of
AAA are also twice as high for white males as for black people and white women.
For the
past 40 years the standard treatment for AAA has remained relatively unchanged.
The current treatment for abdominal aortic aneurysms is open abdominal repair,
an effective treatment that carries risks similar to majority invasive surgery.
During this procedure, a surgeon makes a large abdominal incision and the aorta
is clamped above and below the aneurysm. The aorta is then opened, a surgical
graft is sewn in at the damaged site and the aorta is closed over it.
The open
surgery procedure can last anywhere from two to five hours and has a relatively
high complication rate of 15 to 25 percent. Additionally, the average hospital
stay is seven to twelve days, including time spent in the ICU. Patient recovery
time can last as long as three months.
Recent
clinical trials demonstrated the safety and efficacy of a new treatment
modality in which a stent graft is inserted into the femoral artery (the artery
in the upper thigh) to the aorta through a small incision in the upper leg.
This minimally invasive approach to treating AAA is commonly referred to as
endovascular therapy.
Risk Factors for AAA
Medical Conditions
Arteriosclerosis (hardening of the arteries)
Diabetes
High blood cholesterol
Hypertension (high blood pressure)
Vascular disease
Kidney diseases requiring dialysis
Chronic obstructive pulmonary disease
Inguinal hernias
Personal or family history of heart disease
Lifestyle Characteristics
Diet high in fats
Smoking
Obesity Gender and Age
Predominantly male gender
55 years and older
Warning Signs
In most cases, a person with an abdominal
aortic aneurysm has no symptoms.
Warning signs include abdominal or back pain.
Rupture signs include extreme pain in the
lower abdomen and back.
During a routine patient exam, physicians may
hear a "blowing" murmur or a
"whooshing" sound over the aorta.
Aneurysm
An aneurysm
is a weak area in the wall of a blood vessel that bulges like a balloon when
blood flows through the vessel. Aneurysms can occur throughout the body, and
sometimes they are harmless. But sometimes they are life-threatening. Aneurysm
occurs most commonly in the brain (cerebral aneurysm) or the aorta, the main
blood vessel that supplies blood to the body. An aortic aneurysm may be in the
chest cavity (thoracic aortic aneurysm), but it is most commonly seen in the
abdomen (abdominal aortic aneurysm).
Angina Pectoris
Angina
pectoris is the medical term for chest pain due to coronary heart disease.
Angina is a symptom of a condition called myocardial ischemia. It occurs when
the heart muscle (myocardium) doesn't get as much blood (hence as much oxygen)
as it needs for a given level of work. Insufficient blood supply is called
ischemia.
Angina
pectoris can occur when blood flow to the heart is enough for normal needs but
not enough when the heart's needs increase. Running to catch a bus, for
example, could trigger an attack of angina while walking to a bus stop may not.
It may happen during physical exercise, strong emotions or extreme
temperatures. Some people, such as those with a coronary artery spasm, may have
angina when they're resting.
Angina is a
sign that someone is at increased risk of heart attack.
Arrhythmia
An arrhythmia is an abnormal heart rhythm. The heart can be beating too
rapidly, too slowly or irregularly.
Arteriovenous Malformations (AVM)
AVMs are
blood vessel abnormalities in the brain or elsewhere. If untreated, AVMs can
rupture, causing life-threatening bleeding. Doctors can often treat these
abnormalities without surgery by guiding thin tubes (catheters) to the site and
injecting a substance that blocks the supply of blood to the affected blood
vessels.
Atheroembolism
An
atheroembolism is a cholesterol embolism, with or without calcific matter,
originating from an atheroma of the aorta or other diseased artery.
Atheroma
Atheroma
are the lipid deposits in the intima (innermost lining of the artery) of
arteries, producing a yellow swelling on the endothelial (layer of flat cells
that line the artery) surface. They are characteristic of atherosclerosis.
Atherosclerosis
Atherosclerosis
is characterized by irregularly distributed lipid deposits in the intima
(innermost lining of the artery). It is set in motion when cells lining the
arteries are damaged as a result of high blood pressure (HBP), smoking, toxic
substances in the environment and other agents. Plaques develop when high
density lipoproteins accumulate at the site of the arterial damage and
platelets act to form a fibrous cap over this fatty core. Deposits impede or
eventually shut off the blood flow.
Atrophy is
a condition where there is a reduction in size of a structure (generally
muscle) after coming to full growth and use. It may result from loss of
functional use or disease.
Bleeding Internally
When a
patient is bleeding inside the body due to injured blood vessels after an
accident or other trauma, the doctor pinpoints the area of injury with
angiography. The doctor injects a clotting substance, such as a gel, foam, or
tiny coils, through a thin tube (catheter) to stop the bleeding.
Blood Clots
Blood clots
that form in the deep veins of the lower legs (known as deep vein thrombosis or
DVT) can cause chronic swelling and leg pain when walking. There is a risk that
the clots will move to the lung (pulmonary embolism) or heart where they can
lead to potentially life-threatening complications. Doctors treat DVT by
dissolving the clot with thrombolytic therapy. This treatment opens up blood
flow and may prevent permanent damage to the blood vessels, a common side
effect of DVT.
Blood Pressure
Blood
pressure is force of blood against the walls of the arteries. This pressure is
created by the heart as it pumps blood to all parts of the body. In some
people, blood pressure is nearly always higher than it should be. Doctors still
don't know what causes most high blood pressure, but they can help you control
it.
High blood
pressure adds to the workload of the heart and arteries. The heart must pump
with more force, and the arteries must carry blood that is moving under greater
pressure. If high blood pressure continues for a long time, the heart and the
arteries may not function as well as they should and other body organs may also
be affected. There is increased risk of stroke, heart failure, kidney failure
and heart attack.
Most people
with high blood pressure have no symptoms at all. There are no specific warning
signs. The only way to find out if you have high blood pressure is to have your
doctor check it or visit a local blood pressure screening program.
If you have
high blood pressure, you can do a great deal to reduce it. First, work with
your doctor to determine the best treatment for you. It may include a low-fat
diet, a low-salt diet, and changes in your living habits such as quitting
smoking, losing weight, and getting more exercise. Reducing your alcohol intake
may be recommended. If you are on a weight reduction diet, remember alcohol is
high in
calories.
In
addition, many medications can be used to reduce and control high blood
pressure. Your doctor will decide whether you need drug treatment in addition
to dietary and lifestyle changes.
Cardiac Arrest
Sudden
cardiac arrest is the leading cause of death among adults in North America. It
is a condition in which the heart stops abruptly and unexpectedly. It is usually
caused by an abnormality in the hearts electrical system, called ventricular
fibrillation. The standard of care for sudden cardiac arrest is prompt
cardiopulmonary resuscitation (CPR) plus prompt defibrillation using a device
that delivers electrical current to the heart to restore normal heart rhythm.
Cardiomyopathy
Cardiomyopathy
is a serious disease in which the heart muscle becomes inflamed and doesn't
work as well as it should. There may be multiple causes including viral
infections.
Cardiomyopathy
can be classified as primary or secondary. Primary cardiomyopathy can't be
attributed to a specific cause, such as hypertension, heart valve disease,
artery diseases or congenital heart defects. Secondary cardiomyopathy is due to
specific causes and is often associated with diseases involving other organs as
well as the heart. There are three principal types of cardiomyopathy - dilated,
hypertrophic and restrictive.
Cardiomyopathy, Dilated (congestive)
This is the
most common form of cardiomyopathy. The heart cavity is enlarged and stretched
(cardiac dilation) in contrast to the thickening of the walls in the
hypertrophic form. The heart is weak and doesn't pump normally, and most
patients develop congestive heart failure. Arrhythmias and disturbances in the
heart's electrical conduction also may occur.
Since blood
flows more slowly through an enlarged heart, blood clots easily form. A blood
clot is also called a thrombus. A clot that breaks free, circulates in the
bloodstream and blocks a small blood vessel is called an embolus.
Clots
that stick to the inner lining of the heart are called mural thrombi.
If the
clot breaks off the right ventricle, it can be carried into the pulmonary
circulation in the lung, forming pulmonary emboli.
Blood
clots formed in the left side of the heart may be dislodged and carried into
the body's circulation to form cerebral emboli in the brain, renal emboli in
the kidney, peripheral emboli or even coronary artery emboli.
A condition
known as Barth syndrome, a rare and relatively unknown genetically linked
cardiac disease, can cause dilated cardiomyopathy. This syndrome affects male
children, usually during their first year of life, but it can be diagnosed
later. In these young patients the heart condition is often associated with
changes in the skeletal muscles, short stature and an increased likelihood of
catching bacterial infections. They also have a condition known as neutropenia,
which is a decrease in the number of white blood cells known as neutrophils.
There are clinical signs of the cardiomyopathy in the newborn child or within
the first months of life. Other findings in these children include metabolic
abnormalities.
A person
with congestive cardiomyopathy may suffer an embolus before any other symptom
of cardiomyopathy appears, and anti-clotting (anticoagulant) drug therapy may
be needed. Arrhythmias may require antiarrhythmic drugs. More rarely,
"heart block" may develop, requiring an artificial pacemaker. Therapy
for dilated cardiomyopathy is sometimes disappointing, however. If the person
is young and otherwise healthy, and if the disease gets worse and worse, a
heart transplant may be considered.
When
cardiomyopathy results in marked cardiac dilation, the leaflets of the mitral
and tricuspid valves may not be able to close properly, resulting in murmurs.
Blood pressure may increase because of increased sympathetic nerve activity.
These nerves can also cause arteries to constrict (narrow). This mimics
hypertensive heart disease (high blood pressure). That's why some people have
high blood pressure readings. Because the level of blood pressure determines
the workload and oxygen needs of the heart, one approach in treatment is to use
vasodilators (drugs that "relax" the arteries). They lower blood
pressure and thus the left ventricle's workload.
Cardiomyopathy, Hypertrophic
In this
condition, the muscle mass of the left ventricle enlarges or
"hypertophies." In one form of the disease, the wall between the two
ventricles (septum) becomes enlarged and obstructs the blood flow from the left
ventricle. The syndrome is known as hypertrophic obstructive cardiomyopathy
(HOCM) or asymmetric septal hypertrophy (ASH). It is also called idiopathic
hypertrophic subaortic stenosis (IHSS).
Besides
obstructing blood flow, the thickened wall sometimes distorts one leaflet of
the mitral valve, causing it to leak. In over half the cases, the disease is
hereditary. Close blood relatives (parents, children or siblings) of such
persons often have enlarged septums, although they may have no symptoms. This
disease is most common in young adults. In the other form of the disease, non
obstructive hypertrophic cardiomyopathy, the enlarged muscle doesn't obstruct
blood flow.
The
symptoms of hypertrophic cardiomyopathy include shortness of breath on
exertion, dizziness, fainting and angina pectoris (chest pain). Some people
have cardiac arrhythmias, abnormal heart rhythms that in some cases can lead to
sudden death. The obstruction to blood flow from the left ventricle increases
the work the ventricle must do, and a heart murmur may be heard.
A drug
known as a beta-blocker (such as propranolol) or a calcium channel blocker is
the usual treatment. If a person has an arrhythmia, an antiarrhythmic drug may also
be used. Surgical treatment of the obstructive form is possible in some cases
if the drug treatment fails.
Alcohol
ablation is another nonsurgical treatment being developed for hypertrophic
obstructive cardiomyopathy. It involves injecting alcohol down a small branch
of one of the heart arteries to the extra heart muscle. The procedure results
in the extra heart muscle being destroyed without having to cut it out
surgically.
People
undergoing this procedure usually suffer chest pain during the alcohol
injection. The alcohol can also disrupt normal heart rhythms and require the
insertion of a pacemaker. Alcohol ablation is a relatively new procedure being
performed at only a few specialized centers in the United States. However, it's
too soon to know whether this treatment will result in long-term benefit. It's
still considered experimental.
Cardiomyopathy, Restrictive
This is the
least common type of cardiomyopathy in the United States. The myocardium of the
ventricles becomes excessively "rigid," so that it is harder for the
ventricles to fill with blood between heartbeats. A person with restrictive
cardiomyopathy often complains of being tired, may have swollen hands and feet,
and may have difficulty breathing on exertion. This type of cardiomyopathy is
usually due to another disease process.
Cardiovascular Disease, Congenital
Congenital
means inborn or existing at birth. Among the terms you may hear are congenital
heart defect, congenital heart disease and congenital cardiovascular disease.
The word "defect" is more accurate than "disease." A congenital cardiovascular defect occurs
when the heart or blood vessels near the heart don't develop normally before
birth.
Congenital
cardiovascular defects are present in about one percent of live births. They're
the most common congenital malformations in newborns. In most cases scientists
don't know why they occur. Sometimes a viral infection causes serious problems.
German measles (also called rubella) is an example. If a woman contracts German
measles while pregnant, it can interfere with how her baby's heart develops or
produce other malformations. Other viral diseases also may cause congenital
defects.
Heredity
sometimes plays a role in congenital cardiovascular disease. More than one
child in a family may have a congenital cardiovascular defect, but this rarely
occurs. Certain conditions affecting multiple organs, such as Down's syndrome,
can involve the heart, too. Some prescription drugs and over-the-counter
medicines, as well as alcohol and "street" drugs, may increase the
risk of having a baby with a heart defect.
CPR is an emergency procedure used in the event of heart attack, cardiac
arrest, stroke and other situations involving unconsciousness due to oxygen
deprivation. CPR keeps oxygenated blood flowing to the brain and heart until
more advanced care becomes available.
The
estimated cost of cardiovascular disease in 1999 was $286.5 billion in the
United States. This includes direct costs for health expenditures
(hospitalization, physician care, professional services and home health care)
as well as indirect costs related to lost productivity.
There are
more than 12-million deaths/year world wide from cardiovascular disease. Many
cardiovascular events are not fatal but account for 25-30% of disabilities
worldwide.
Cardiovascular Disease,
International Mortality Rates
Male death
rates from total cardiovascular disease have decreased by 60% in Japan, and by
50% in Australia, Canada, France and the United States over the past 2 decades.
Female mortality rates for those countries follow a similar pattern.
In
developed and developing countries combined, about 50% of deaths are related to
cardiovascular disease. Premature death (less than 65 years of age) is 40 per
100,000 in France and 248 per 100,000 in Latvia. Premature death is 2.5 times
higher for men than for women.
Africa, Western Asia and Southeast Asia
There are 20 million deaths per year, 20% of which are
related to cardiovascular disease.
Eastern Mediterranean
About 45% of deaths in this region are related to
cardiovascular disease.
India and China
Cardiovascular disease is the cause of death for 5 million
people annually (about 36% of the total number of deaths).
The Americas
In 31 of 35 countries, cardiovascular disease is the number
one cause of death.
United States
58.8 million people in the US have one or more forms of
cardiovascular disease:
Hypertension 50 million
CAD 12 million
AMI 7 million
Angina 5
million
Cardiovascular
Disease, Risk Factors for
Age
Gender
Family History
Race
Hypertension
Physical Inactivity
Stress, Emotion, Tension
Hormone
Replacement Therapy
Type II
Diabetes often related to being overweight
Cardiovascular Disease, Screening
To detect heart disease in its earliest, most treatable
stages, age specific physical examinations and screening tests are recommended.
Examinations may include amongst others:
History & Physical (H&P)
Diagnostic, Blood & Urinalysis
Chest X-ray
Cardiac Ultrasound
Stress Echocardiogram or Thallium Study
Carotid Ultrasound
Abdominal Aortic Ultrasound
Abdominal X-ray
Prostate Specific Antigen (PSA)
Cardiovascular and Endovascular
Disease, Common Locations for Aneurysmal Disease
Cerebral
Thoracic
Aortic Arch
Abdominal Aorta
Femoral
Popliteal
Cardiovascular and Endovascular
Disease, Common Locations for Arterial Occlusive Disease
Carotid
Vertebral
Aortic Arch
Superior Mesenteric
Renal
Abdominal Aortic
Aortoiliac Junction
Common Iliac
Internal Iliac
External Iliac
Common Femoral
Profunda Femoris
Superficial Femoral
Popliteal
Tibial (anterior and posterior, peroneal)
Cardiovascular and Endovascular
Disease, Common Locations for Venous Thrombosis
Pulmonary trunk
Upper extremities
Lower extremities
Also called
Carotid Artery Stenosis, this disease is a narrowing of the carotid arteries usually caused by plaque. This
condition is a major risk factor for ischemic stroke.
Emphysema or chronic bronchitis (often brought about by cigarette
smoking) can result in chronic obstructive pulmonary disease. The resulting
high blood pressure in the lungs can lead to heart disease.
Claudication
Claudication
is a burning or aching pain experienced by patients who have peripheral
vascular disease. This pain is located in the muscles of the calf, thigh or
biceps and is felt during the exertions of normal daily living. The severity of
pain is usually proportionate to the severity of the disease.
Congenital
Heart Defects
These are structural problems which occur during heart development within
the fetus prior to birth.
Congestive Heart Failure (CHF)
Congestive
heart failure is the inability of the heart to pump enough blood throughout the
body. This causes a build-up of fluids that can lead to life-threatening
complications. This disorder afflicts some 4 million Americans.
Coronary heart disease is caused by atherosclerosis within the coronary
arteries and often results in chest pain and/or a heart attack.
Cranial
nerve palsies occasionally occur as a result of carotid endarterectomy. These
palsies are characterized by localized paralysis (partial or full) at various
sites above the neck.
Deep
Vein Thrombosis (DVT)
This is a condition in which blood clots form in the deep veins of the
lower legs. DVT can cause chronic swelling and leg pain when walking. There is
a risk that these clots will dislodge and move to the lungs (pulmonary
embolism) or to the heart.
Diabetes results from the bodys
inability to produce or accommodate the hormone insulin. This disease is a
major risk factor for stroke and coronary heart disease.
Dissection
This is a
pathological separation of layers of a vessel wall causing collection of blood
in the space between these layers.
An embolism
occurs when a wandering blood clot (embolus) encounters a narrow region within
a vessel and becomes lodged, thus reducing or blocking circulation.
Uncomfortable pressure, fullness, squeezing or pain in the center of the chest
lasting more than a few minutes
Pain
which spreads to the shoulders, neck and/or arms
Chest
discomfort accompanied by lightheadedness, fainting, sweating, nausea or
shortness of breath
Not all of
these signals occur in every attack. If some occur, get help fast!
(Congestive)
heart failure is a condition wherein the heart is incapable of pumping
sufficient blood to satisfy the requirements of the bodys other organs.
Hematoma
This is a
collection of blood (usually clotted) that has been confined within an organ or
other tissue. It is caused by a break in a blood vessel.
High Blood Pressure, in Women
Many people
think of high blood pressure (hypertension) as a "stress disease";
that it is the result of overwork, no exercise, too many cocktail lunches, too
much smoking, bad diet and a thousand other things we do in our tense society.
With few exceptions, doctors don't know what causes high blood pressure. What
they do know is that more than 63 million Americans have it, and nearly half of
those are women. Remarkably, only a fraction of those with this disease are
being adequately treated.
High blood
pressure is a killer. It leads to heart failure, stroke, kidney damage and
more. There are no reliable symptoms indicating high blood pressure. As a
woman, you should be aware of some clues that may help you deal with this
disease.
Doctors
have determined that taking contraceptive pills is associated with high blood
pressure in some women. This is more likely to happen if you are overweight,
have had hypertension during pregnancy, or have a predisposing condition, such
as mild kidney disease or a family history of high blood pressure. So it's a
good idea to ask your doctor to measure your blood pressure before prescribing
the Pill and then to have your blood pressure checked every six months or so.
The combination of contraceptive pills and cigarette smoking may be especially
dangerous in susceptible women.
Physicians
usually keep a close watch on blood pressure during pregnancy because
hypertension can develop rapidly in the last three months and is dangerous to
both mother and baby if not treated. This kind of hypertension usually
disappears after delivery. If it does not, it should be controlled with careful,
long-term treatment.
As for
women who already have high blood pressure, pregnancy may make the condition
more severe. Careful treatment will greatly improve the chances for a normal
pregnancy and a healthy baby.
Being
overweight or a sudden weight gain enhances the possibility of developing high
blood pressure. This is one good reason to maintain normal weight throughout
your life.
As a woman
grows older, a high blood pressure condition becomes a greater risk than that
for a man. Although you may have had normal blood pressure most of your life,
the chance of getting high blood pressure increases considerably after
menopause.
Nobody
knows why, but studies show that African American women (even very young
African American women) are much more susceptible to high blood pressure than
white women. Not only is the disease more common among African American women,
but it often tends to be more serious. In fact, more than one in every three
African American women over age 18 is estimated to have high blood pressure.
If your
parents and other relatives have had high blood pressure, there's a good chance
that you have it or may develop it, as well. And if you have it, it's quite
possible that your children may also develop it. Like adults, children should have
regular blood-pressure checks.
You may
have to take medication every day, perhaps for the rest of your life. There
also may be other treatments, such as losing weight, using less salt, getting
more exercise and limiting alcohol intake.
See high
blood pressure.
Hypertrophy
Hypertrophy
is an increase in size of an organ or muscle produced by the enlargement of the
existing cells.
An inguinal
hernia occurs in the groin area and it can involve the deep epigastric artery.
Myocardial
ischemia is a condition where the heart muscle (myocardium) doesnt get as much
oxygen-rich blood as it needs for a given level of work. The result is chest
pain or angina pectoris.
Peripheral Vascular Disease (PVD)
PVD is a
disease of the blood vessels that affects tens of thousands of people. In PVD,
the arteries that carry blood to the arms or legs become narrowed or clogged,
slowing or stopping the flow of blood. The disease most often affects the legs;
sometimes PVD occurs in the arms. Many people live with the symptoms of PVD --
such as pain or numbness in the legs or arms -- because they mistakenly believe
it is a normal part of aging. PVD does not have to be a part of growing older,
and the condition can often be treated.
PVD is
caused by atherosclerosis, or hardening of the arteries. Atherosclerosis is a
gradual process in which cholesterol and scar tissue build up inside the
artery. Symptoms of PVD also can develop when a blood clot forms in the artery.
The most
common symptom of PVD is leg pain, particularly when walking or exercising,
which goes away after a few minutes of rest. Other symptoms:
Numbness
and tingling in the lower legs and feet
Coldness
in the lower legs and feet
Ulcers or
sores on the legs and feet that don't heal
PVD occurs
most often in people who are over age 50. Men are also more likely to be
affected than women. Factors that contribute to the disease include smoking,
high blood pressure, diabetes, high cholesterol, a family history of heart or
vascular disease, and being overweight.
Sometimes
PVD can be controlled or prevented by lifestyle changes, such as exercising and
dieting to lose weight and lower blood cholesterol. The single most important
thing you can do to slow PVD is to stop smoking.
The best
treatment for PVD depends on a number of factors, including your overall
health, the location of the affected artery, and the size and nature of the
blockage or narrowing in the artery. In many cases, PVD can be treated without
surgery.
Plaque is
the buildup of cholesterol and other fatty substances on the inner lining of an
artery.
Stenosis
A stenosis
is a stricture of any canal, especially a narrowing of one of the coronary
valves.
Stroke
A stroke
occurs when part of the brain is deprived of the blood supply that brain cells
need to survive. There are two types of stroke:
The most
common is when a blood clot lodges in the blood vessels that carry oxygen to
the brain. This is called an ischemic stroke, and accounts for more than 80
percent of all strokes. If the resulting impairment is temporary, lasting only
minutes or a few hours, it's called a transient ischemic attack (TIA) TIAs
should be taken as seriously as stroke.
A leading
cause of stroke and TIA is carotid artery disease (CAD). In CAD, a substance
called plaque builds up over time in the carotid arteries, the large blood
vessels on either side of the neck that supply blood to the head and brain. The
buildup of plaque is a silent disease, until small particles break away and are
carried to smaller arteries, where they block the flow of blood. The nature and
severity of symptoms depend on how large an area of the brain is affected and
whether the blood supply to the brain is completely or partially blocked.
Less
frequently, strokes are caused by bleeding within the brain. This is called a
hemorrhagic stroke. Such strokes are usually the result of a ruptured blood
vessel or an aneurysma weakened area of a blood vessel that bulges or balloons
out. Sometimes, abnormal tangles of blood vessels in the brain, called
arteriovenous malformations (AVM) can rupture and cause a hemorrhagic stroke.
Approximately 20% of strokes are hemorrhagic. This is the most common type of
stroke in young people.
The most
common symptoms of stroke are:
Sudden
numbness or weakness in the face, arm and/or leg, especially on one side of the
body
Sudden
confusion, or difficulty speaking or understanding speech
Sudden
problems seeing, including double vision, blurred vision or partial blindness,
in one or both eyes
Dizziness, trouble walking, loss of balance or coordination
A severe,
unexplained headache that comes on suddenly
If you
experience any of these symptoms, even if they go away quickly, seek immediate
emergency help. Every minute counts. Although starved of oxygen, brain tissue
does not die in the minutes following a stroke. If blocked blood vessels can be
opened within three to six hours, the chances of recovery are greatly improved.
Less common
symptoms that may be signs of stroke are listed below. If you experience them,
call your doctor immediately:
Nausea,
fever and vomiting that comes on quickly
Loss of
consciousness or decreased consciousness, fainting, confusion
Seizures
People who
are at higher-than-average risk for stroke include those who have:
High
blood pressure. High blood pressure, or hypertension, puts stress on the walls
of blood vessels and can lead to strokes from blood clots or hemorrhage. Half
or more of all stroke victims have uncontrolled high blood pressure.
Fortunately, this risk factor for stroke can be controlled. Eating a balanced
diet, maintaining a healthy weight and exercising regularly can help control
high blood pressure. Medications that lower blood pressure also may be prescribed.
Heart
disease. Approximately 15% of all stroke victims have a common heart rhythm
disorder called atrial fibrillation (AF), that results when the upper chambers
of the heart (the atria) beat rapidly and out of rhythm. AF is associated with
aging and also can be caused by heart or thyroid disease. AF increases stroke
risk because it allows blood to pool in the heart and form clots that can be
carried to the brain.
Atherosclerosis. When the carotid arteries, the major blood vessels that supply
blood to the brain, become clogged with atherosclerotic plaque, the risk for
stroke goes up.
Personal
history of stroke or TIA. People who have already suffered a stroke or TIA are
at increased risk of having another. Modifying risk factors for stroke,
including lifestyle changes (e.g., exercise, stop smoking), medications and/or
other treatments can reduce this risk.
Lifestyle
risk factors. Smoking, excessive alcohol consumption and being overweight are
all significant risk factors for stroke.
Age,
gender and race. The risk of stroke goes up with age, with two-thirds of all
strokes occurring in individuals age 65 years or older. Males have a slightly
higher risk than females and African Americans and Hispanics have a higher
stroke risk than most other racial or ethnic groups.
Family
history of stroke or TIA. If others in your family have suffered stroke, you
may be at higher risk. Regular physical exams, lifestyle changes and medical
treatments may reduce this risk.
Diabetes.
People with diabetes are at increased risk for stroke, although keeping
diabetes under control with diet and/or medication may help to decrease the
risk.
Hyper-homocysteinemia. Elevated homocysteine
levels in the blood have been identified as a risk factor for heart attack and
stroke that may be as important as high cholesterol. Homocysteine is a
by-product of the process that metabolizes methionine, an amino acid essential
in human nutrition.
A
hemorrhagic stroke occurs when a blood vessel in the brain bursts, allowing
blood to escape into the brain cavity.
An ischemic stroke occurs when the blood supply to the brain is
interrupted. This can occur when a blood clot lodges in the vessels that carry
this blood.
A
thrombosis is the formation or presence of a blood clot (thrombus) within a
blood vessel or a heart cavity.
A thrombus
is another name for a blood clot that forms within a blood vessel or cavity of
the heart.
A transient
ischemic attack is quite similar to an ischemic stroke except that it lasts but
a few minutes. The same processes are involved and the victim is at great risk
for the occurrence of a stroke.
Vascular
diseases are diseases of the blood vessels.