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CEREBRAL AND CARDIOVASCULAR RISK &
IDENTIFICATION
LARRY WILSON, MD, FACEP
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Stroke Risk & Identification
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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
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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
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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
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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
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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
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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.
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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
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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
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Medication that may Help Manage Risk
Antihypertensives- reduce blood pressure Antidysrhythmics- control Atrial
Fibrillation Anticoagulants- decrease clotting risk Anticholesterol/lipid medications Diabetic medications
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What is Heart Disease?
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Prevalence of Heart Disease
Affects 25% of the US population. Each year: Claims 1 million lives Cost $290 billion
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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
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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
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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
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If Symptoms Develop- Seek Immediate Care
Time is heart muscle Treating heart disease:
Medications Angioplasty and Stenting Bypass Implantable devices
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Risk Factors Predict the Development of Heart
Disease
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Non-modifiable Risk Factors
Age Race Gender Family History Diabetes
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Modifiable Risk Factors Blood Pressure Cholesterol Smoking Diabetes Obesity Physical Fitness
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Blood Pressure Rarely causes symptoms Strains Heart Muscle and increased heart
oxygen use Damages blood vessels
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Blood Pressure Classification
Class SBP DSPNormal <120 <80Pre HTN 120-139 80-89Stage 1 140-159 90-99Stage 2 > 160 > 100
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30% do not know that they have High Blood Pressure
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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
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Diabetes Single greatest risk factor predicting
heart disease
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Diabetes contributes to: High Blood Pressure High LDL cholesterol High Triglycerides Low HDL cholesterol Irritates blood vessel walls
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Diabetes Risk of developing heart disease: Women: 5-7 times Men: 2-3 times
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Lipids and Lipoprotiens Good: HDL Bad: LDL Ugly: VLDL
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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
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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
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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
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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
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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
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Influence of Diet Polyunsaturated fats and
Monounsaturated fats- healthiest Saturated fats- less good Trans fats- the worst
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High fiber and low glycemic index
Fruits and Vegetables Whole grains Brans Unrefined cereals
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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
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Healthy Habits Low salt Control blood sugar Know your numbers
Blood Pressure Lipid Panel Blood Glucose
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Tests for a Healthy HeartUnder 40:
Blood PressureLipid ProfileBlood Chemistry
Over Age 40:UrinalysisEKGStress Test
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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
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Cerebral and Cardiovascular Care
?