Cerebral and Cardiovascular Risk & Identification
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Transcript of Cerebral and Cardiovascular Risk & Identification
CEREBRAL AND CARDIOVASCULAR RISK &
IDENTIFICATION
LARRY WILSON, MD, FACEP
Stroke Risk & Identification
Stroke in perspective 3rd leading cause of death Leading cause of serious long term
disability in the U. S. Women more likely to die from a stroke
than men On average, every 40 seconds someone
has a stroke
What a Stroke? Death of brain cells leading to loss of
neurological function Two types
Ischemic Stroke: blocked circulation to a part of the brain usually due a blood clot, often in a narrowed artery
Hemorrhagic Stroke: ruptured blood vessel, usually arterial, causing circulation loss to part of the brain
87% if strokes are ischemic and 13% hemorrhagic
Transient Ischemic Attack (TIA) Temporary neurological symptoms in the
distribution of a blood vessel that blocks, and then clears
Usually develop stroke like symptoms that resolve in 60 minutes or less
Similar to Angina preceding a heart attack
Stroke Symptoms F.A.S.T. Face: facial droop on one side: ask the
person to smile Arms: Loss of coordination or
weakness/numbness on one side- hold both arms straight out from the body- does one drift downward?
Speech: Ask the person to repeat a simple sentence- was it repeated normally?
Time: Get to the Hospital immediately if any of the above are abnormal: Time is Brain
Stroke Symptoms Less common, but potentially stoke
symptoms: New type of severe headache Sudden Nausea/Vomiting Sudden sleepiness or agitation Ataxia- staggering while moving, clumsiness
Stroke Risk Factors Blood pressure: increased risk for blood pressure
above 120/80 Cholesterol: Should be less than 200 mg/dl Diabetes Smoking Diet: know your Body Mass Index- BMI less than 24 Exercise: cardiovascular fitness reduces stroke risk Family History: Increased risk if immediate family
members with heart or cerebral vascular disease at an early age.
Reducing the Risk of Stroke
Check blood pressure and work with a doctor to achieve BP less than 120/80
Have your cholesterol checked and work on reduction if elevated
Check for diabetes If a smoker, work on smoking cessation Drink alcohol in moderation
Reducing the Risk of Stroke
Have an ECG or heart rhythm evaluation to check for Atrial Fibrillation
Develop an exercise habit Enjoy a reduced fat and sodium diet
Medication that may Help Manage Risk
Antihypertensives- reduce blood pressure Antidysrhythmics- control Atrial
Fibrillation Anticoagulants- decrease clotting risk Anticholesterol/lipid medications Diabetic medications
What is Heart Disease?
Prevalence of Heart Disease
Affects 25% of the US population. Each year: Claims 1 million lives Cost $290 billion
Heart Disease in the U.S.2004- 1 of every 5 deathsEvery 26 seconds someone suffers a heart attackEvery 1 minute someone will die from a heart attack
Warning Signs of a Heart Attack
Uncomfortable pressure, heaviness, squeezing or pain in the center of the chest lasting at least 2 minutes.
Pain the travels to the shoulders, arms, neck, jaw or back
Severe pain, lightheadedness, fainting, sweating, nausea or shortness of breath
Atypical Symptoms Women, diabetics, the elderly Unusual fatigue New, unusual shortness of breath with
everyday activity or while a rest Nausea or Dizziness Stomach or lower chest pain; back pain
If Symptoms Develop- Seek Immediate Care
Time is heart muscle Treating heart disease:
Medications Angioplasty and Stenting Bypass Implantable devices
Risk Factors Predict the Development of Heart
Disease
Non-modifiable Risk Factors
Age Race Gender Family History Diabetes
Modifiable Risk Factors Blood Pressure Cholesterol Smoking Diabetes Obesity Physical Fitness
Blood Pressure Rarely causes symptoms Strains Heart Muscle and increased heart
oxygen use Damages blood vessels
Blood Pressure Classification
Class SBP DSPNormal <120 <80Pre HTN 120-139 80-89Stage 1 140-159 90-99Stage 2 > 160 > 100
30% do not know that they have High Blood Pressure
Achieve Desirable Blood Pressure
Reduce weight Keep salt intake to less than a teaspoon
daily- both added and in foods Assure eating plenty of fruits and
vegetables; low-fat dairy products Exercise Reduce stress Medications
Diabetes Single greatest risk factor predicting
heart disease
Diabetes contributes to: High Blood Pressure High LDL cholesterol High Triglycerides Low HDL cholesterol Irritates blood vessel walls
Diabetes Risk of developing heart disease: Women: 5-7 times Men: 2-3 times
Lipids and Lipoprotiens Good: HDL Bad: LDL Ugly: VLDL
Cholesterol Levels HDL
Women- 60 mg/dl or higher Men- 50 mg/dl or higher
LDL Normal 90-100 mg/dl Desire < 100 mg/dl In heart disease or diabetics: goal < 70 mg/dl
VLDL- highest triglycerides Desire below 20 mg/dl
Obesity and Heart Disease Extra weight adds strain to the heart and
cardiovascular system Since 1991 obesity has increased 75% 7 of ten adults are overweight Body Mass Index: BMI
Exercise and Heart Disease Active persons reduce cardiovascular risk
by 50% Opportunity to Exercise: OTE
Walk stairs Park farther from store front or walk/bike to
store Take walk breaks during the day Partner up: walk/run/bike/gym
Exercise Improves blood lipid profile Burns calories and reduces weight Improves blood pressure Improves blood sugar control Decreases depressed moods Decreases stress Improves energy and confidence
Tobacco and Heart Disease Tobacco use increases the probability of
Heart Disease Nicotine:
Speeds development of atherosclerosis Decreases HDL cholesterol levels Binds carbon monoxide to Red Blood Cells,
decreasing oxygen delivery tissue
Influence of Diet Polyunsaturated fats and
Monounsaturated fats- healthiest Saturated fats- less good Trans fats- the worst
High fiber and low glycemic index
Fruits and Vegetables Whole grains Brans Unrefined cereals
Be Pro-Active Healthy Habits
Maintain healthy weight- BMI < 24. Physical activity Non-smoker Eating Habits:
Fruits and vegetables Low fat dairy Low total fat Avoid saturated and trans fats
Healthy Habits Low salt Control blood sugar Know your numbers
Blood Pressure Lipid Panel Blood Glucose
Tests for a Healthy HeartUnder 40:
Blood PressureLipid ProfileBlood Chemistry
Over Age 40:UrinalysisEKGStress Test
Proactive Care No your numbers
Seek treatment for BP, DM, cholesterol Eat right and get regular exercise Watch your weight Smoking cessation Recognize symptoms
Seek immediate care
Cerebral and Cardiovascular Care
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