Something We All Never Want!

By Dr. A. Mossavi

More women at risk than men

More women will die from Coronary Artery Disease than from the other leading causes of death combined:  cancer, chronic obstructive pulmonary disease, Alzheimer’s, Diabetes, and accidents.  Heart disease, heart attacks and stroke claim the lives of more American women than men each year.  Many women don’t realize the symptoms of a woman having a stroke can be significantly different than those of a man.

A stroke, or cerebrovascular accident (CVA), occurs when blood supply to part of the brain is disrupted, causing brain cells to die. When blood flow to the brain is impaired, oxygen and glucose cannot be delivered to the brain. Blood flow can be compromised by a variety of mechanisms.

What causes a stroke?

The blockage of an artery in the brain by a clot (thrombosis) is the most common cause of a stroke. The part of the brain that is supplied by the clotted blood vessel is then deprived of blood and oxygen. As a result of the deprived blood and oxygen, the cells of that part of the brain die. Typically, a clot forms in a small blood vessel within the brain that has been previously narrowed due to a variety of risk factors including:

• high blood pressure (hypertension)
• high cholesterol
• diabetes
• smoking

Types of Strokes:

Embolic stroke

This often occurs when a blood clot or a piece of atherosclerotic plaque (cholesterol and calcium deposits on the wall of the inside of the heart or artery) breaks loose, travels through open arteries, and lodges in an artery of the brain. When this happens, the flow of oxygen-rich blood to the brain is blocked and a stroke occurs. An embolism can also originate in a large artery (for example, the carotid artery, a major artery in the neck that supplies blood to the brain) and then travel downstream to clog a small artery within the brain.

Cerebral hemorrhage

A cerebral hemorrhage occurs when a blood vessel in the brain ruptures and bleeds into the surrounding brain tissue. A cerebral hemorrhage (bleeding in the brain) can cause a stroke by depriving blood and oxygen to parts of the brain. Blood is also very irritating to the brain and can cause swelling of brain tissue (cerebral edema). Edema and the accumulation of blood from a cerebral hemorrhage increases pressure within the skull and causes further damage by squeezing the brain against the bony skull.

Subarachnoid hemorrhage

In a subarachnoid hemorrhage, blood accumulates in the space beneath the arachnoid membrane that lines the brain. The blood originates from an abnormal blood vessel that leaks or ruptures .Often this is from an aneurysm (an abnormal ballooning out of the wall of the vessel). Subarachnoid hemorrhages usually cause a sudden, severe headache and stiff neck. If not recognized and treated, major neurological consequences, such as coma, and brain death will occur.

Vasculitis

Another rare cause of stroke is vasculitis, a condition in which the blood vessels become inflamed.

Migraine headache

There appears to be a very slight increased occurrence of stroke in people with migraine headaches. The mechanism for migraine or vascular headaches includes narrowing of the brain blood vessels. Some migraine headache episodes can even mimic stroke with loss of function of one side of the body or vision or speech problems. Usually, the symptoms resolve as the headache resolves.

What are stroke symptoms in men and women?

When brain cells are deprived of oxygen, they cease to perform their usual tasks. The symptoms that follow a stroke depend on the area of the brain that has been affected and the amount of brain tissue damage.
Small strokes may not cause any symptoms, but can still damage brain tissue. These strokes that do not cause symptoms are referred to as silent strokes. According to The U.S. National Institute of Neurological Disorders and Stroke (NINDS), these are the five major signs of stroke:

Women may report unique stroke symptoms

What is the impact of strokes?

In the United States, stroke is the third largest cause of death (behind heart disease and all forms of cancer). The cost of strokes is not just measured in the billions of dollars lost in work, hospitalization, and the care of survivors in nursing homes! The major cost or impact of a stroke is the loss of independence that occurs in 30% of the survivors. What was a self-sustaining and enjoyable lifestyle may lose most of its quality after a stroke and other family members can find themselves in a new role as caregivers.

What can be done to prevent a stroke?

One of the first steps is to get diagnosed to see if you are at risk for this serious condition. Dr. Mossavi  specializes in non invasive cardio evaluation. By taking advantage of a free carotid artery ultrasound, you will be screened for blockage, which if present, may increase your risk of having a stroke.

Diagnostic Testing

In order for us to recommend the most appropriate treatment for your cardiac problem, we must first understand its nature and extent. The results of your tests will be available to you as soon as possible and we will review the results with you and advise you of your treatment options.

Electrocardiogram (ECG or EKG)

This test records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias) , and detects heart muscle damage. This test can determine if you have had a previous heart attack, if you have heart enlargement or if you are currently having a heart attack. The procedure, which requires that sticky tabs be placed on your chest to hold transmitting wires in place, is painless.

Echocardiogram (Echo)

This test uses sound waves to look at your heart. The doctor can look at your heart walls, valves, and the blood flow through your heart. Ejection fraction- the volume of blood ejected during each contraction-is measured with this procedure. An Echo is painless and requires you to lie quietly as a scanner probe is moved over your chest.

Exercise Stress Test (Treadmill Test)

While you walk on a treadmill at different levels of intensity, your blood pressure and heart will be monitored. This test allows your us to gauge how your heart responds to different levels of exertion and also indicates whether your EKG changes during exercise. Wear comfortable walking shoes if you are scheduled for this test.

Exercise Thallium Scan (Myocardial Perfusion Scan)

This is a nuclear scan that’s given while the patient is exercising and may reveal areas of the heart muscle that are not getting enough blood.

Persantine Thallium Scan ( Myocardial Perfusion Scan)

This is also a nuclear scan given to a patient who is unable to exercise and reveals areas of the heart muscle that are not getting enough blood.

Holter Monitor

This is a small portable, battery-powered ECG machine worn by a patient to record heart beats on tape over a period of 24-48 hours- during normal activities. At the end of the time period, the monitor is returned to the physician’s office so the tape can be read and evaluated.

Event Recorder

This is a small portable battery powered machine used by the patient to record ECG over a long period of time. Patients may keep the recorder up to several weeks. Each time a symptom is experienced, the person presses a button on the recorder to record the ECG sample. As soon as possible, this sample is transmitted to the physician’s office by telephone hookup for evaluation.

Carotid Artery Ultrasound

An ultrasound of the body’s two carotid arteries, which are located on each side of the neck and carry blood from the heart to the brain, provides detailed pictures of these blood vessels and information about the blood flowing through them. The major goal of carotid artery ultrasound is to screen patients for blockage, which if present, may increase the risk of having a stroke. Once a diagnosis is made, a comprehensive treatment will be initiated.
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Once the diagnostic testing is completed, your risks for stroke will be evaluated. A comprehensive treatment will be initiated to help prevent you from suffering a stroke. We can perform more extensive testing to determine any other coronary issues you may have concerns about.