Your heart is not the only potential victim of cardiovascular disease. Your brain can be, too. Stroke is a type of cardiovascular disease that affects the arteries leading to and within the brain. A stroke occurs when the blood vessels that carry the oxygenated blood and nutrients to the brain are either blocked by a clot or break.

This prevents the brain from getting the oxygen and nutrients it needs, and within minutes to a few hours brain cells begin to die. Every 45 seconds someone in the United States has a stroke, and every three minutes someone dies of stroke. That’s about seven hundred thousand strokes a year, of which about 160,000 result in fatalities.

I can’t stress enough how important it is to learn how to recognize the symptoms of stroke because it can save your life or the life of someone you know. The most characteristic symptom is a sudden numbness, weakness, or paralysis of the face, arm, or leg, usually on one side of the body. Other symptoms include loss of speech or trouble talking, blurry vision, double vision, decreased vision, dizziness, loss of balance and coordination, an out-of-the-blue bolt of pain, headache, vomiting, or altered consciousness and disorientation or memory loss. Usually these symptoms strike suddenly and without warning.

It is important to recognize the signs and symptoms of stroke because every minute counts when it comes to treating one. The longer a stroke goes untreated, the greater the damage and potential disability. So if you have any of the signs and symptoms of stroke, it is important to get help immediately.

Eighty percent of strokes are ischemic, which means they are caused by an obstruction from a blood clot or particle of cholesterol plaque that reduces the blood flow to the brain. The brain cells die within minutes of this happening. There are two types of ischemic stroke. Thrombotic strokes are caused by clots that originate in the arteries that supply the brain, like the neck arteries, or the arteries within the head itself. Embolic strokes originate from blood clots that form away from the heart but are swept up through the bloodstream and into the narrow arteries of the brain.

The other 20 percent of strokes are hemorrhagic; they occur when a blood vessel in the brain leaks or breaks. The most common risk factor for hemorrhagic stroke is uncontrolled hypertension, though it can also be caused by an anatomical weakness of the blood vessel itself, that is, an aneurysm, or by an abnormal connection of the arteries and veins in the brain.

There are several risk factors for stroke.

People who have transitory ischemic attacks—a temporary halt to the flow of blood to the brain—have a ninefold increase of developing a full-blown stroke. At higher risk are those who have a family history of stroke, are older (the older we get, the greater the chance of stroke), and are African American, partly due to the high prevalence of high blood pressure and diabetes among the black community.

Other factors include hypertension, high cholesterol, cigarette smoking, diabetes, obesity, cardiovascular disease, and high homocysteine levels. Homocysteine is an amino acid in the blood, and people with elevated homocysteine levels have a higher risk of stroke. Women taking birth control pills or hormone replacement therapy may also be at higher risk for stroke.

The good news is that there actually are some things you can do to avoid being a victim of stroke. Even though you cannot do anything about your race, your sex, your family history, or your age, since cardiovascular disease and stroke go hand in hand, you certainly can look at your risk factors for heart disease and hypertension and focus on early screening.

Get your blood pressure checked; learn what your body mass index is; and check your cholesterol and glucose levels every two to five years.

Exercise, manage your stress, limit your alcohol consumption, don’t smoke, and stay away from foods with saturated fats.

Take a vitamin B complex, like B6, B12, and folic acid, which are essential in helping to reduce the levels of homocysteines in the body.

Don’t take illicit drugs, like cocaine, which may trigger a stroke.

People with risk factors for stroke should consider a brain-healthy diet that includes several servings daily of fruit and vegetables with nutrients rich in potassium, folate, and antioxidants. Eat foods high in soluble fiber, like oatmeal, to help reduce cholesterol, as well as foods rich in calcium and soy that help reduce your bad cholesterol and raise your good cholesterol. Foods rich in omega-3 fatty acids, which include, of course, plant oils, salmon and other cold-water fish like tuna, are also good weapons in the battle against stroke.

When it comes to the treatment of strokes, some hospitals have actually established special stroke emergency rooms that are manned by a multidisciplinary team well versed in their diagnosis and treatment. Whoever the doctor is, however, he or she must first determine the type of stroke and its location before treating it.

A wide variety of diagnostic tests are available to the doctor, and they all fall into one of three categories: imaging tests, which provide a better-than–X-ray picture of the brain; electrical tests, which record the impulses in the brain; and blood flow tests, which show any problem that may be causing changes in blood flow to the brain.

Essentially, all emergency room doctors will attempt to improve and restore blood flow to the brain of a stroke victim. One way to do that is by injecting a clot-bursting drug, or thrombolytic, that helps dissolve the clot. Other techniques include performing a surgical procedure such as a carotid endarterectomy, in which the surgeon opens the carotid arteries and removes the plaque from them, or angioplasty, in which a balloon-tipped catheter dilates the arteries to improve the blood flow.

Once a stroke has been diagnosed and treated, most individuals end up taking preventive medicines to minimize the chances of recurrence. Some may receive antiplatelet drugs to make platelet cells in the blood less sticky and less likely to form a clot, or anticoagulants, which again prevent the blood from clotting. In cases of hemorrhagic stroke, where a blood vessel has ruptured, surgical intervention is needed to minimize further bleeding by clipping, cauterizing, or removing the clot and any vessel that is actively bleeding.

Stroke survivors must cope with a life-changing experience. They are often significantly disabled and, as a result, need a strong support system. Usually the support system is a team of rehabilitation doctors, which might include a psychiatrist, a dietitian, an occupational therapist, a physical therapist, a speech therapist, and social workers.

A stroke victim has to deal with impaired movement, which has implications for walking, balancing, speaking, swallowing, and breathing; bladder and bowel dysfunction; and diminished sex drive—as well as all the emotional issues that result from those problems. A stroke victim’s family is also profoundly affected because they now have to take part in caring for the individual.

Stroke can change your life completely, so learn to recognize it and treat it urgently to minimize the terrible disabilities it can inflict on its victims.

The Other Victims of Stroke

The obvious result from a major stroke is devastating disability—such as speech impairment, weak hand and leg movement, and depression. But a stroke can also have an indirect effect on the health of the victim’s family and friends.

Imagine a very strong and vibrant man who has never been sick, who has been a good husband and provider, who has been a great father. His family, and especially his wife of 45 years, marveled at his strength. He was healthy and looking forward to a peaceful and blessed retirement. Then one day he suffered a major stroke, which left him unable to speak and walk. For the family, the confusion and shock were intense. How could this have happened?

This is not a fictional story. It happened in my family. When I first met my future father-in-law, I never imagined that one day his life would end up in such a way. However, this same scenario is played out over and over again in many families across the United States and around the world.

All of a sudden, responsibilities that were the stroke victim’s are now delegated to other members of the family, and in some cases the majority of the responsibilities falls on the spouse. From everyday things like shopping or paying bills to new responsibilities like making daily trips to the rehabilitation center; feeding, bathing, and keeping up with all the medications; and becoming a motivational guru.

All of this can have a tremendous impact on the caregiver’s health. Suddenly, what was once an ordinary life becomes an extraordinary one burdened by the pressure and eased by the love for the ailing family member. We doctors sometimes forget about the families, and that’s a big mistake. When dealing with stroke survivors, focusing on the family as a whole is always important. We must listen, support the changes that are needed, and monitor stress and the effect that it has on the people taking care of stroke survivors.

Family members take care of one another; they become the pillars of health care in the home and improve the outcome that any therapy in the hospital could bring. I remember the look of my mother-in-law as she dealt with her husband’s disabilities, a look of love, duty, and compassion. But we must always make sure that, as we take care of others, we take care of ourselves.

If you don’t take care of your own health, you may very well end up being unable to take care of the person you love. So stay healthy. They don’t say “in sickness and in health” for nothing.

Clench your fist—that’s about the size of your heart. Located in the center of your chest, the heart beats about one hundred thousand times a day, pumping five to six quarts of blood per minute.

Once the blood receives oxygen from the lungs, the heart sends the blood from the aorta through the arteries and into the capillaries, which are smaller, thinner blood vessels. Then, once the capillaries have brought oxygen and nutrients to every cell in the body, the blood is redeposited into the veins, and from there it goes back to the heart for the cycle to begin again.

So what we have here is a plumbing system essentially, a smart pump with different connecting parts that circulates blood throughout the body. The heart itself is made up of four chambers—the two up top are called the atria, the two on the bottom are called the ventricles—connected by a set of valves. And the whole system is set in motion, or beats, thanks to the electrical impulses sent out by a small bundle of specialized cells in the right atrium that act as the heart’s natural pacemaker, causing the muscles of this organ to contract and relax.

Any malfunction of this blood pump is known as heart disease, of which one of the most common types is coronary artery disease. It is the number-one killer of both men and women in the United States. Half a million people die of it each year, and more than 12 million people have the disease.

Coronary artery disease, also known as coronary heart disease, is a narrowing and obstruction of the coronary arteries, which are responsible for bringing oxygen and nutrients to the heart itself. As early as your teen years, fat deposits begin to develop in some of these arteries, and as time goes by, the fat deposits build up, ultimately creating an obstruction that begins to decrease the amount of blood to the heart and cause an inflammation as the artery tries to heal itself.

Over time the fat deposits in the arteries begin to harden, and you begin to get deposits of small platelets that compound the obstruction. All of this can lead not only to a significant narrowing of the arteries, but to blood clots that may either obstruct the artery or get dislodged and create further obstructions elsewhere in the plumbing system.

One of the consequences of this narrowing or total obstruction of the coronary artery is ischemia, which occurs when there is an insufficient supply of oxygenated blood for the heart muscle. Any activity—eating, excitement, or changes in temperature—can make the problem worse.

One of the most common symptoms of ischemia is angina, which is a discomfort, heaviness, pressure, numbness, or squeezing feeling in the chest. Sometimes it is mistaken for indigestion or heartburn. It is usually felt in the chest, but it can also migrate to the arms, especially the left shoulder. Other symptoms include shortness of breath, irregular heartbeats or palpitation, a very fast heartbeat, nausea, and sweating. If this ischemia is not corrected, if it lasts more than 30 minutes and does not get better, a heart attack may result.

In a heart attack, the heart muscle begins to fail, either through a very erratic electrical stimulation called an arrhythmia or by stopping altogether. It is important to recognize these symptoms because early intervention could save your life.

A doctor can tell you if you have coronary artery disease by discussing your symptoms, especially shortness of breath, taking your medical history, and looking at your risk factors, in particular, smoking, cholesterol, blood pressure, and sugar control. There are a host of diagnostic tests your doctor can do, such as an electrocardiogram (ECG or EKG); an exercise stress test; an ultrafast CAT scan, which looks for calcium deposits in your coronary artery; and cardiocatheterization, which can help determine the degree of obstruction of the artery.

If you are diagnosed with coronary artery disease, treatment is threefold. The first has to do with lifestyle changes, like quitting smoking, starting to exercise, and keeping to a low-fat, low-sodium, low-cholesterol diet.

The second aspect of treatment is medication, which may be needed to get your heart working more effectively. Other medication will be prescribed to reduce the cholesterol.

The third aspect of treatment has to do with procedures to help improve the blood flow through the coronaries. One possibility is a balloon angioplasty, in which a small balloon-tipped catheter is inserted into the coronary arteries and then inflated to open up the clogged artery. Another possibility is placing a small, metal stent inside the artery to keep it open and improve blood flow.

A heart bypass operation takes place when total replacement of the piece of the coronary that is obstructed becomes necessary.

Plumbing Vs. Electrical Problems

Other types of cardiac disease have nothing to do with obstruction of the coronaries but with the way the electrical system of the heart works. Sometimes the specialized cells that electrically stimulate the heart become dysfunctional, and you can develop an arrhythmia, where the heart beats either too slowly, too quickly, or out of sync. These conditions can be diagnosed with an electrocardiogram, and sometimes medications alone can help to regulate the rhythm.

Another common problem is heart failure. This occurs when the heart can no longer effectively pump all the blood that it receives. Heart failure affects about five million Americans, and it’s the leading cause of hospitalization of people older than 65. Many times, heart failure is due to prior damage caused by coronary artery disease, or by arrhythmias that have weakened the function of the heart. Ultimately, heart failure creates a backlog of pressure into the lungs, and people with heart failure tend to have difficulty breathing. Depending on the cause of the heart failure, different medications are available for treating it.

The valves of the heart are another source of heart problems. The valves can be damaged at birth or through infection. Abnormal or infected valves can interfere with normal blood flow and heart function and can lead to major cardiac disease. Surgery may be needed to replace the valves.

Sometimes the lining of the heart may be infected, a condition called pericarditis. If this membrane is inflamed, the heart may not beat properly. Valve abnormalities, arrhythmias, and heart failure all have a common symptom—shortness of breath or difficulty catching your breath. If you have this problem, see a cardiologist to get the correct diagnosis and treatment.

The heart is a remarkable organ. It is the core of life, and its beat is central to your survival. Keeping it in prime working order is of paramount concern.

All for One and One for All

When we talk about heart attacks, we tend to describe them in a way that suggests there are different kinds of heart attacks. But those are just words to describe our experience of the same underlying disease.

Number one is the silent heart attack. Here you don’t have major chest pain, you don’t have shoulder pains, you may have a little palpitation, but you’re not tired, you’re not fatigued, and you’re not dizzy. However, when you go in for a physical, the doctor finds that you have had a silent heart attack.

Number two is typical angina. This is the chest pressure that doesn’t go away, and you have thirty minutes to get yourself to an emergency room.

Number three is the sudden heart attack. This occurs when you have a major, catastrophic obstruction in a main branch of the coronary artery, and a very large area of your heart is instantly void of any blood.

Even though the three heart attacks described here evolve differently, the underlying theme is the same—they all involve chronic coronary artery disease. In other words, you don’t go around with a normal coronary artery one day and the next day develop a major clot. That’s just not the way it works. The heart attack may present itself differently in different people, but the cause is the same no matter how we experience the critical moment.

A Heart Test for Venusians

What works for men, doesn’t always work for women. We all know that, but medicine is just catching up to the fact.

The standard test for heart disease is known as an angiogram. In this test a dye is injected into the coronary arteries, which are then X-rayed to look for blockages. The test is very effective in detecting heart disease in men, but a new study has discovered that this test often misses the symptoms of heart disease in women. When the tests turn up nothing, women are given a clean bill of health, even though as many as 3 million women could be at risk with a buildup of fatty deposits that could ultimately interfere with blood flow to the heart and cause a heart attack.

Hidden heart disease may be a significant problem in women. It appears that one cause may be due to a phenomenon called arterial remodeling. This means that the artery dilates as plaque is deposited in the blood vessel so that, in the early stages of atherosclerosis or coronary artery disease, very little overall narrowing is seen on an angiogram. But late in the disease, the deposits may overwhelm the body’s ability to compensate by remodeling, and severe narrowing or complete blockage can occur. If this happens, a sudden heart attack can result.

To diagnose heart disease in women, physicians will now have to use the new generation of CT scanners and magnetic resonance scanners, which can visualize the heart’s blood vessels with ever-greater detail. In many cases, these tests can detect problems before a stress test or a conventional angiogram. Physicians should test for the presence of coronary artery disease in women who have risk factors for heart disease such as diabetes, hypertension, high cholesterol, a family history of heart disease or stroke, or nicotine use.

The moral of this story is: paying closer attention to the vast differences between men and women could save lives—in this case, women’s lives.

Which Fruit Are You?

Researchers have long noted the importance of body shape in determining a person’s risk factors for heart disease. They talk about the apples versus the pears. The apples tend to store their access fat in their stomach and chest. The pears store it below the hips, in their thighs and buttocks. A recent study found that a person’s waist-to-hip ratio is an even better predictor of cardiovascular risk than their body mass index, or BMI, the commonly used ratio of weight to height. It appears that a large waist size, which generally indicates large amounts of abdominal fat, is more harmful than a larger hip size.

Determine your body shape and risk for cardiovascular disease by calculating your waist-to-hip ratio. First, measure your waist at its smallest circumference; then, measure your hips at their widest. Next, divide your waist measurement by your hip measurement. For example, a person with a thirty-six-inch waist and forty-inch hips would have a waist-to-hip ratio of 0.9. Waist-to-hip ratios over 0.85 in women and over 0.9 in men are strongly associated with an increased risk for heart disease.