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Cerebral and Cardiovascular Risk & Identification

Cerebral and Cardiovascular Risk & Identification. Larry Wilson, MD, FACEP. Stroke Risk & Identification. Stroke in perspective. 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

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Cerebral and Cardiovascular Risk & Identification

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  1. Cerebral and Cardiovascular Risk & Identification Larry Wilson, MD, FACEP

  2. Stroke Risk & Identification

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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.

  9. 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

  10. 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

  11. Medication that may Help Manage Risk • Antihypertensives- reduce blood pressure • Antidysrhythmics- control Atrial Fibrillation • Anticoagulants- decrease clotting risk • Anticholesterol/lipid medications • Diabetic medications

  12. What is Heart Disease?

  13. Prevalence of Heart Disease • Affects 25% of the US population. • Each year: • Claims 1 million lives • Cost $290 billion

  14. Heart Disease in the U.S. 2004- 1 of every 5 deaths Every 26 seconds someone suffers a heart attack Every 1 minute someone will die from a heart attack

  15. 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

  16. 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

  17. If Symptoms Develop- Seek Immediate Care • Time is heart muscle • Treating heart disease: • Medications • Angioplasty and Stenting • Bypass • Implantable devices

  18. Risk Factors Predict the Development of Heart Disease

  19. Non-modifiable Risk Factors • Age • Race • Gender • Family History • Diabetes

  20. Modifiable Risk Factors • Blood Pressure • Cholesterol • Smoking • Diabetes • Obesity • Physical Fitness

  21. Blood Pressure • Rarely causes symptoms • Strains Heart Muscle and increased heart oxygen use • Damages blood vessels

  22. Blood Pressure Classification ClassSBPDSP Normal <120 <80 Pre HTN 120-139 80-89 Stage 1 140-159 90-99 Stage 2 > 160 > 100

  23. 30% do not know that they have High Blood Pressure

  24. 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

  25. Diabetes • Single greatest risk factor predicting heart disease

  26. Diabetes contributes to: • High Blood Pressure • High LDL cholesterol • High Triglycerides • Low HDL cholesterol • Irritates blood vessel walls

  27. Diabetes • Risk of developing heart disease: • Women: 5-7 times • Men: 2-3 times

  28. Lipids and Lipoprotiens • Good: HDL • Bad: LDL • Ugly: VLDL

  29. 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

  30. 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

  31. 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

  32. 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

  33. 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

  34. Influence of Diet • Polyunsaturated fats and Monounsaturated fats- healthiest • Saturated fats- less good • Trans fats- the worst

  35. High fiber and low glycemic index • Fruits and Vegetables • Whole grains • Brans • Unrefined cereals

  36. 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

  37. Healthy Habits • Low salt • Control blood sugar • Know your numbers • Blood Pressure • Lipid Panel • Blood Glucose

  38. Tests for a Healthy Heart Under 40: Blood Pressure Lipid Profile Blood Chemistry Over Age 40: Urinalysis EKG Stress Test

  39. 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

  40. Cerebral and Cardiovascular Care ?

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