Hospital Heart Attacks And Strokes: Risks And Prevention

Heart attacks and strokes are both medical emergencies caused by a sudden interruption of blood flow. They are closely related and often share the same risk factors, including lifestyle and family history. In the US, more than 1.5 million people have a heart attack or stroke every year. Heart attacks occur when blood flow to the heart is blocked, most commonly by a blood clot. Strokes happen when blood flow to the brain is disrupted, often by a blood clot in a blood vessel that feeds the brain. Both conditions require timely medical care to lower the damage to the affected organ and improve the chances of survival and recovery.

Heart attack and stroke symptoms

Heart attacks and strokes are two of the top killers of both women and men in the US. They are caused by interruptions to the normal flow of blood to the heart or brain, which are essential for sustaining life. Without access to oxygen-rich blood and nutrients, the cells in these organs start to malfunction and die. This cell death can set off a series of harmful effects throughout the body.

Heart Attack Symptoms

Heart attacks can be sudden and intense, but they can also start slowly, with mild pain or discomfort. The major symptoms of a heart attack are:

• Sustained, crushing chest pain or discomfort that lasts for more than a few minutes or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, or fullness.
• Pain or discomfort in other areas of the upper body, including one or both arms, the back, neck, jaw, or stomach.
• Shortness of breath, which often comes along with chest discomfort but can also happen before it.
• Breaking out in a cold sweat, nausea, or lightheadedness.
• Unusual or unexplained tiredness.
• Pain in the left arm or jaw stiffness.

Stroke Symptoms

To recognize the warning signs of a stroke, remember the acronym BE FAST:

• Balance: Look out for a sudden loss of balance.
• Eyes: Watch for a sudden loss of vision in one or both eyes, or double vision.
• Face: Ask the person to smile and look for drooping on one or both sides of the face, which is a sign of muscle weakness or paralysis.
• Arms: Check for muscle weakness on one side by asking the person to raise both arms. If they have one-sided weakness, one arm will drift downward.
• Speech: Strokes often cause a person to lose their ability to speak, slurring their speech or having trouble choosing the right words.
• Time: Time is critical, so don't wait to get help!

Other symptoms of a stroke include:

• Numbness or weakness of the face, arm, or leg, especially on one side of the body.
• Confusion, trouble speaking or understanding speech.
• Severe headache with no known cause.

Risk factors

Heart attacks and strokes are closely related and are both medical emergencies caused by a sudden interruption of blood flow. While a heart attack occurs when blood flow to the heart is blocked, a stroke happens when blood flow to the brain is disrupted. Both conditions share several risk factors, including lifestyle and family history. Here are some key risk factors for heart attacks and strokes:

High Cholesterol

High cholesterol levels in the blood can increase the risk of both heart attacks and strokes. Cholesterol can build up on the walls of blood vessels, leading to the formation of plaques. If a plaque breaks open, it can result in the formation of a blood clot, which can cause a blockage. Therefore, maintaining healthy cholesterol levels through lifestyle changes and, if necessary, medication, is crucial for reducing the risk of these conditions.

High Blood Pressure

Hypertension, or high blood pressure, is another significant risk factor for both heart attacks and strokes. Unlike high cholesterol, high blood pressure usually presents with no symptoms, so regular monitoring at home or during doctor visits is important. Controlling blood pressure through lifestyle modifications, such as exercise and a healthy diet, as well as medication, can help lower the risk of these serious conditions.

Diabetes

Diabetes, or high blood sugar, is a risk factor for heart attacks and strokes. Complications arising from diabetes, such as obesity, can further increase the risk of these events. Therefore, managing blood sugar levels and maintaining a healthy weight through a combination of lifestyle changes and medical interventions is important for reducing the likelihood of heart attacks and strokes.

Lack of Physical Activity

A lack of regular physical activity is a risk factor for both heart attacks and strokes. Engaging in regular physical activity, such as 30 minutes of heart-strengthening exercise five days a week, can significantly lower the chances of experiencing these life-threatening events.

Family History

A family history of heart attacks or strokes can increase an individual's risk of experiencing the same. While this factor cannot be changed, being aware of one's family history allows for increased vigilance and the adoption of preventive measures, such as maintaining a healthy lifestyle, to reduce the likelihood of experiencing these conditions.

Previous Heart Attack or Stroke

A previous heart attack is a significant risk factor for a subsequent stroke, and vice versa. Therefore, individuals who have experienced either of these events are at an increased risk of having another, emphasizing the importance of preventive measures and ongoing medical care to reduce the chances of recurrence.

Treatments

Heart Attack

If you suspect someone is having a heart attack, call 9-1-1 immediately. Treatment can start in an ambulance on the way to the hospital.

Upon arrival at the hospital, doctors can administer clot-busting drugs and other emergency procedures. Hospitals use techniques to restore blood flow to the part of the heart muscle damaged during a heart attack. You might receive clot-dissolving drugs (thrombolysis), balloon angioplasty, surgery, or a combination of treatments.

There are two types of heart attack: STEMI and NSTEMI. STEMI is a complete blockage of a coronary artery, while NSTEMI is a partial blockage. Treatments differ for these two types, although there can be some overlap.

If a hospital is equipped to perform percutaneous coronary intervention (PCI), a mechanical means of treating heart attacks, you would likely be sent to an area that specializes in cardiac catheterization, sometimes called a "cath lab." There, a diagnostic angiogram can examine blood flow to your heart and reveal how well your heart is pumping. Depending on the results of that procedure, you may be routed to one of three treatments: medical therapy only, PCI, or coronary artery bypass grafting (CABG).

A hospital that is not equipped to perform PCI might transfer you to one that is. Or your medical team may decide to administer drugs to break down a clot and restore blood flow. You might be given an angiogram—an imaging technique used to see inside your arteries, veins, and heart chambers. This may be followed by surgery to restore the blood circulation in your heart.

If the health care team determines you had an NSTEMI heart attack, they typically use one of two treatment strategies: the ischemia-guided strategy or the early invasive strategy. The ischemia-guided strategy uses blood thinners to stop a blood clot from forming. The early invasive strategy starts with the use of blood thinners and might also proceed to medical therapy, a PCI with stenting, or CABG, followed by certain types of post-hospital care.

Heart attack treatment involves a variety of drugs, including anticoagulants, antiplatelet agents, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, angiotensin receptor neprilysin inhibitors, beta-blockers, combined alpha and beta blockers, calcium channel blockers, cholesterol-lowering medications, and vasodilators.

Stroke

If you suspect someone is having a stroke, call 9-1-1 immediately. Treatment can start in an ambulance on the way to the hospital.

The treatment for a stroke depends on the kind of stroke a person has. The two main types of stroke are ischemic and hemorrhagic. Ischemic strokes are caused by a clot that clogs a blood vessel in the brain, while hemorrhagic strokes are caused by a hemorrhage—when a blood vessel breaks and bleeds into the brain.

With ischemic strokes, the top priority is restoring circulation to the affected brain areas. This usually involves thrombolytic drugs but may also involve a catheterization procedure. Thrombolytic drugs are only an option within the first three to four and a half hours after stroke symptoms start, as after that, they increase the risk of dangerous bleeding complications.

With hemorrhagic strokes, treatment depends on the location and severity of the bleeding. Reducing blood pressure is often the top priority, as this will reduce the amount of bleeding and keep it from getting worse. Another treatment option is to improve clotting so the bleeding will stop. Surgery is sometimes necessary to relieve pressure on the brain from accumulated blood.

Some examples of treatments for stroke are as follows: thrombolytic drugs, blood pressure management, thrombectomy, reversal of any medication that might increase bleeding, use of medications or surgery to reduce pressure inside the skull, blood pressure management, and mechanical thrombectomy.

Lifestyle changes

Diet

A healthy diet is one of the best weapons against heart disease. Choose a diet rich in vegetables, fruits, whole grains, legumes, nuts, plant-based proteins, lean animal proteins, and fish. Opt for low-fat dairy, skinless poultry, legumes, nontropical vegetable oils, and nuts. Limit your intake of red and processed meats, saturated and trans fats, added sugars, sugar-sweetened beverages, and sodium. The food you eat can affect other risk factors such as cholesterol, blood pressure, glucose levels, and weight, so it is important to make smart choices.

Physical Activity

Sitting less and moving more is one of the best ways to stay healthy and prevent disease. Aim for at least 150 minutes of moderate-intensity physical activity or 75 minutes of vigorous activity per week. Even if you are currently inactive, start slowly and gradually increase your activity levels. Research shows that physical activity can help lower blood pressure, cholesterol, and weight, all of which are risk factors for heart attack and stroke.

Weight Management

Maintain a healthy weight by coordinating your diet with your physical activity level. Even modest weight loss of 5% to 10% of body weight can reduce your risk. Weight loss can also help improve blood pressure, cholesterol, and control diabetes, which is a significant risk factor for heart attack and stroke.

Quit Smoking

Smoking is a major risk factor for heart disease and stroke. If you smoke, quitting is crucial. It may be challenging, but it is essential for reducing your risk and improving your overall health. Seek support and proven methods to help you kick the habit.

Manage Stress

Chronic stress can lead to high blood pressure and contribute to poor health behaviors such as smoking, overeating, and physical inactivity. Find healthy ways to manage stress, such as regular exercise, spending time with loved ones, and practicing relaxation techniques.

Alcohol Consumption

Drinking too much alcohol can raise blood pressure, increase the risk of cardiomyopathy, stroke, and other diseases. It can also contribute to obesity and irregular heartbeats. If you don't drink, don't start. If you do drink, limit yourself to one drink per day for women and two drinks per day for men.

Sleep

Getting a good night's sleep is vital for heart health. Aim for 7-9 hours of quality sleep each night. Improve your sleep quality by being physically active during the day, establishing a bedtime routine, and keeping electronic devices out of the bedroom.

Long-term effects

The long-term effects of a heart attack can vary depending on the severity and extent of damage caused to the heart. While some people may experience a "minor" heart attack without any associated complications, others may suffer from extensive damage to the heart muscle, which can lead to a range of complications, including:

• Arrhythmias: Abnormal heartbeats that can cause the heart to beat too quickly, too slowly, or irregularly. Arrhythmias can develop due to damage to the heart muscles, which disrupts the electrical signals that control the heart. Some types of arrhythmias can be life-threatening, such as complete heart block and ventricular arrhythmia, which can lead to sudden cardiac arrest.
• Heart failure: This occurs when the heart is unable to effectively pump blood around the body due to extensive damage to the heart muscle, usually in the left ventricle. Symptoms of heart failure include swelling in the arms and legs due to fluid buildup.
• Cardiogenic shock: A more serious form of heart failure, where the heart muscle is so extensively damaged that it can no longer pump enough blood to maintain the body's functions. This can lead to symptoms such as decreased urination, rapid heartbeat and breathing, and difficulty breathing.
• Heart rupture: A rare but extremely serious complication where the heart's muscles, walls, or valves split apart due to significant damage during a heart attack. This can cause heart failure or cardiogenic shock, and often requires open-heart surgery to repair the damage.

Additionally, people who have had a heart attack are at an increased risk of a second heart attack, especially within the first 90 days after the initial event. To prevent another heart attack, it is crucial to follow a treatment plan and adopt a heart-healthy lifestyle, which may include taking prescribed medications, attending follow-up appointments, participating in cardiac rehabilitation, managing risk factors such as high blood pressure and high cholesterol, and making lifestyle changes such as quitting smoking, eating healthily, and getting regular physical activity.

The long-term effects of a stroke depend on which part of the brain was damaged and the extent of the damage. Early treatment and rehabilitation are crucial for improving recovery, and many people are able to regain a significant amount of function. However, a stroke can cause permanent loss of function, and some common long-term disabilities include:

• Impaired speech: Difficulty with finding the right words, understanding speech, or forming words and sentences.
• Restricted physical abilities: Weakness, paralysis, or loss of control on one side of the body, affecting movement and the ability to perform physical activities.
• Difficulty with fine motor skills: Problems with gripping or holding objects, as well as performing certain movements even without physical disability (apraxia).
• Fatigue or tiredness: This can be caused by physical changes, medication side effects, mood changes, depression, anxiety, or sleep disturbances.
• Incontinence: Different types of incontinence can occur due to medication side effects, muscle weakness, changes in sensations, thinking, or memory.
• Pain: This can be nociceptive pain, caused by damage to tissues, or neuropathic pain, caused by damaged nerves sending incorrect signals to the brain.
• Emotional and personality changes: Strokes can cause changes in mood and personality, including depression, anxiety, irritability, aggressiveness, apathy, repetitive behaviour, disinhibition, and impulsiveness.
• Cognitive changes: A stroke can impact thinking, memory, and perception, affecting skills such as learning new tasks, problem-solving, attention, orientation, and short-term memory.
• Visual and perceptual changes: Loss of vision in half of the visual field in each eye (hemianopia), difficulties recognizing shapes and objects, and impaired perception of contact, heat, or cold on the affected side of the body.
• Communication difficulties: Weakness in the muscles used for speech (dysarthria) or dysfunction of the nerve connection between the brain and mouth (dyspraxia) can make speaking and communication challenging.
• Changes in everyday life: A stroke may lead to modifications in living arrangements, sexual function and relationships, the ability to drive or work, and a loss of independence, requiring reliance on caregivers.

Frequently asked questions