You’ve had a Stroke, Now What?Jul 15, 2014
Dr. Miller: You have had a stroke. How did that happen and how to prevent that from happening again in the future. We will talk about that next on Scope radio. I am Dr. Tom Miller.
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Dr. Miller: I am here today with Dr. Dana DeWitt. She is a professor in neurology and a stroke specialist in the University of Utah, the department of neurology. Tell us a little bit about why people have strokes. You have had a stroke, what causes a stroke?
Dr. DeWitt: There are different causes of stroke and it's important that when you have a stroke, to be evaluated by someone who helps determine why it happened. A stroke can occur from a clot coming from the heart, it can occur from a clot coming from one of the arteries in your neck or it can occur because you either have a blood vessel in brain break, or a small blood vessel in the brain close off.
Dr. Miller: But the results, are many time, the same. Is that right?
Dr. DeWitt: Yes.
Dr. Miller: Debilitating problems.
Dr. DeWitt: Debilitating problems, focal deficits, often they don't recover.
Dr. Miller: So Dana, tell me a little bit about the causes behind those embolic, those pieces of tissues that break off or vessels that bruise. What are the main things that cause that to happen? Lifestyle things that might cause another stroke in a patient?
Dr. DeWitt: So, we well know that smoking is one of the major causes of hardening of the arteries and high blood pressure. It's a major risk factor for stroke. We know that high blood pressure is also a big risk factor for stroke. High blood pressure can cause blood vessels in brain to thicken, it can be one of the causes for [inaudible 00:01:35] and can also cause heart disease. And then we know that cardiac conditions, people who have had heart attacks, whose heart doesn't pump normally and then there is the irregular heart beat called atrial fibrillation which carries a high risk of stroke. And that's when a certain part of the heart called the atrium, actually becomes a little stretched and fibrillates and clog can form in the heart.
Dr. Miller: What about age? Is age related to stroke?
Dr. DeWitt: Well, we know well that as people get older, the risk of stroke is greater. We also do see in young people on occasion, sometimes that can be due to hyper-coagulable or clotting [inaudible 00:02:15] problems or something called dissection in blood vessels or tears in blood vessels, but the major strokes occur in older patients
Dr. Miller: Men and women about the same?
Dr. DeWitt: There is a high risk of stroke in men. Then again cause of stroke in women is a little different except if the women was a smoker and had hyper tension and high cholesterol for years, then her risk is the same.
Dr. Miller: So now I am assuming that if you had a stroke, your risk of having another stroke is higher, higher than the average population risk. Is that true?
Dr. DeWitt: It is. Evaluating those patients is why that's so important. There is also something called a TIA, which is really transient ischemic which is a stroke like event, presumed caused by the same thing that causes a stroke but it clears quickly, and patients then are also at risk for stroke within a short period of time. So it's an important thing for a doctor to evaluate you for your blood pressure. If you are a smoker, you need to stop smoking. You need to know what your cholesterol is and treat your cholesterol, and you need to have your heart evaluated to see if you might have atrial fibrillation or some other cardiac risk?
Dr. Miller: It's true. I think that many people that have atrial fibrillation may not know that.
Dr. DeWitt: That's very true. Atrial fibrillation, we are founding more and more about it but it maybe that atrial fibrillation actually isn't seen at the time that the stroke occurs. It may actually be found later and there are now methods, 30 day monitors or what we call loop recorders, which are implantable recorders that watch over a heart for a long period of time to see if atrial fibrillation occurs. Heart ultrasound, called an echo cardiogram can sometimes tell us if the heart is abnormal in a way that can put patient at risk for atrial fibrillation. It's very important because the treatment is...
Dr. Miller: And those work better to reduce the risk of stroke in the future than aspirins?
Dr. DeWitt: Yes. For atrial fibrillation, absolutely. So it is important to know whether that occurs and whether that needs to be treated in that way.
Dr. Miller: let me ask you a couple of other questions. How about the IBTs, is there a risk of stroke [inaudible 00:04:25] which is diabetes?
Dr. DeWitt: There is a risk of stroke with diabetes. Diabetes is part on the blood vessels and it can promote more atherosclerosis. It also causes damage to very small blood vessels which can cause small deep strokes. We know that patients with diabetes sometimes get damage to the arteries and their retina, in their eye, and also in their kidneys. So the same process can happen in the brain and cause strokes.
Dr. Miller: How about just obesity in general. People who are not in very good shape, they are overweight, they are not working out much.
Dr. DeWitt: That carries a risk as well. Metabolic syndrome, we know, is kind of a pre diabetic condition but patients who are obese are also more prone to high blood pressure. They are more prone to high cholesterol and those carry risk of stroke.
Dr. Miller: It sounds to me like high blood pressure, diabetes, possible cardiac functions if your heart is pumping well or not and an abnormal rhythm in the heart could all contribute to second stroke. So, what would you say to the person out there that has had a stroke or had a family member with a stroke? Do you think that many of them know their risk factors or they should really be aggressive in trying to find out if those problems we just mentioned are high risk factors?
Dr. DeWitt: I think that's extremely important. We talk about primary stroke prevention versus secondary stroke prevention. One is, to know your risk factors so that the stroke never happens and you treat them aggressively. The other is, once you have a stroke, know why the stroke occurred so that you can prevent another one by again, controlling those risk factors. And again, those risk factors really are high blood pressure, smoking, high cholesterol, diabetes and then obesity and inactivity carry another risk. Mainly because they promote the other problems.
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