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3 rd leading cause of death Leading cause of serious long term disability in the U. S. Women more...

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48
CEREBRAL AND CARDIOVASCULAR RISK & IDENTIFICATION LARRY WILSON, MD, FACEP
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Page 1: 3 rd 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,

CEREBRAL AND CARDIOVASCULAR RISK &

IDENTIFICATION

LARRY WILSON, MD, FACEP

Page 2: 3 rd 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,

Stroke Risk & Identification

Page 3: 3 rd 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,

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

Page 4: 3 rd 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,

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

Page 5: 3 rd 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,

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

Page 6: 3 rd 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,

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

Page 7: 3 rd 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,

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

Page 8: 3 rd 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,

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.

Page 9: 3 rd 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,

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

Page 10: 3 rd 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,

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

Page 11: 3 rd 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,

Medication that may Help Manage Risk

Antihypertensives- reduce blood pressure Antidysrhythmics- control Atrial

Fibrillation Anticoagulants- decrease clotting risk Anticholesterol/lipid medications Diabetic medications

Page 12: 3 rd 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,

What is Heart Disease?

Page 13: 3 rd 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,
Page 14: 3 rd 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,

Prevalence of Heart Disease

Affects 25% of the US population. Each year: Claims 1 million lives Cost $290 billion

Page 15: 3 rd 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,

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

Page 16: 3 rd 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,
Page 17: 3 rd 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,
Page 18: 3 rd 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,
Page 19: 3 rd 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,
Page 20: 3 rd 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,

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

Page 21: 3 rd 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,

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

Page 22: 3 rd 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,
Page 23: 3 rd 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,
Page 24: 3 rd 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,
Page 25: 3 rd 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,

If Symptoms Develop- Seek Immediate Care

Time is heart muscle Treating heart disease:

Medications Angioplasty and Stenting Bypass Implantable devices

Page 26: 3 rd 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,

Risk Factors Predict the Development of Heart

Disease

Page 27: 3 rd 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,

Non-modifiable Risk Factors

Age Race Gender Family History Diabetes

Page 28: 3 rd 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,

Modifiable Risk Factors

Blood Pressure Cholesterol Smoking Diabetes Obesity Physical Fitness

Page 29: 3 rd 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,

Blood Pressure

Rarely causes symptoms Strains Heart Muscle and increased heart

oxygen use Damages blood vessels

Page 30: 3 rd 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,

Blood Pressure Classification

Class SBP DSPNormal <120 <80Pre HTN 120-139 80-89Stage 1 140-159 90-99Stage 2 > 160 > 100

Page 31: 3 rd 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,

30% do not know that they have High Blood Pressure

Page 32: 3 rd 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,

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

Page 33: 3 rd 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,

Diabetes

Single greatest risk factor predicting heart disease

Page 34: 3 rd 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,

Diabetes contributes to:

High Blood Pressure High LDL cholesterol High Triglycerides Low HDL cholesterol Irritates blood vessel walls

Page 35: 3 rd 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,

Diabetes

Risk of developing heart disease: Women: 5-7 times Men: 2-3 times

Page 36: 3 rd 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,

Lipids and Lipoprotiens

Good: HDL Bad: LDL Ugly: VLDL

Page 37: 3 rd 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,

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

Page 38: 3 rd 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,

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

Page 39: 3 rd 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,

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

Page 40: 3 rd 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,

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

Page 41: 3 rd 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,

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

Page 42: 3 rd 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,

Influence of Diet

Polyunsaturated fats and Monounsaturated fats- healthiest

Saturated fats- less good Trans fats- the worst

Page 43: 3 rd 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,

High fiber and low glycemic index

Fruits and Vegetables Whole grains Brans Unrefined cereals

Page 44: 3 rd 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,

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

Page 45: 3 rd 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,

Healthy Habits

Low salt Control blood sugar Know your numbers

Blood Pressure Lipid Panel Blood Glucose

Page 46: 3 rd 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,

Tests for a Healthy Heart

Under 40:Blood PressureLipid ProfileBlood Chemistry

Over Age 40:UrinalysisEKGStress Test

Page 47: 3 rd 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,

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

Page 48: 3 rd 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,

Cerebral and Cardiovascular Care

?


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