Heart & Stroke Conditions Explained

Definition

Stroke

What is a Stroke? A stroke occurs when a blood vessel, which is carrying oxygen and nutrients to the brain, bursts or is blocked by a clot.

This causes an interruption of the blood supply to part of the brain. This can damage or destroy brain cells which will affect body functions.

A stroke is a medical emergency. Therefore, recognising the symptoms and accessing treatment immediately can be crucial.

The term ‘stroke’ comes from the fact that it usually happens without warning, ‘striking’ the person from out of the blue. The effects of a stroke on the body are immediate.

 

Very treatable if action is taken quickly.

Until recently many people, including doctors, believed little or nothing could be done following a stroke. We now know strokes are very treatable and, if the right actions are taken quickly, the patient may not have any long term effects.

 

One in five people, and at any age.

One in five people will have a stroke at some time in their life. Most are over 65, but stroke can strike at any age. Even young people and children can be affected.

 

The more you know, the better.

A stroke could happen to you, a friend or family member. If it does, the more you know about stroke the better you will be able to deal with the consequences.

See our simple test to recognise a stroke called Act F.A.S.T. in our symptoms section.

 

What is a TIA or a ‘mini-stroke’?

TIA stands for transient ischaemic attack. It is also known as a mini-stroke and happens when the brain’s blood supply is briefly interrupted, usually for a few minutes but occasionally as long as 24 hours.

A mini-stroke may cause a brief loss of vision, loss of speech, or weakness in one side of the body. People will usually recover within a few minutes and won’t have any obvious disability.

TIA should be treated as an emergency and you should seek urgent medical attention for assessment. Without assessment and treatment, about one in four people who have had a TIA will go on to have a full-blown stroke within a few years.

TIAs are caused by small clots. A large clot causes a stroke. A mini-stroke is a warning that there is a risk of more TIAs, or a full blown stroke.

 

Related Topics: Blood Pressure, Smoking, Cholesterol, Overweight, Stress, Diabetes, Being Active, Atrial Fibrillation, How Your Heart Works, Atherosclerosis.

Symptoms

Stroke

Stroke symptoms include:

  • Numbness, weakness, or paralysis on one side of the body
  • Slurred speech, difficulty thinking of words or understanding other people
  • Confusion
  • Sudden blurred vision or sight loss
  • Being unsteady on your feet
  • Severe headache

 

The right half of the brain controls the left side of the body and vice versa. For example, weakness or paralysis in the left arm may result from a stroke in the right side of the brain.

For most people, the left side of the brain controls language (talking, reading, writing, understanding). The right side controls perceptual skills (making sense of what you see, hear, touch) and spatial skills (judging size, speed, distance, position).

 

When Stroke Strikes, Act F.A.S.T.

A simple test can help you recognise if someone has had a stroke:

Facial weakness – can the person smile? Has their mouth or eye drooped?

Arm weakness – can the person raise both arms?

Speech problems – can the person speak clearly and understand what you say?

Time – call 999 for an ambulance if you spot any one of these signs.

Every minute counts. Don’t wait for the symptoms to go away. Early medical treatment can prevent further damage to the brain and reduce the likelihood of death and disability.

It is also recommended, especially if you live in a rural area, to know your Eircode so that emergency services can find your home or workplace instantly.

You can view and share our Act F.A.S.T. awareness campaign advert here: https://youtu.be/_PW4rhZokS8

Causes

Stroke

A stroke happens when the blood supply to a part of your brain is cut off causing your brain cells to become damaged or destroyed.

There are two main types of stroke.

 

1. Ischaemic Stroke:

Over 80% of strokes are caused by a blockage of an artery supplying blood to the brain. This is known as an ischaemic stroke. It is caused by:

A blood clot that forms in a main blood vessel (artery) to the brain. This is called a cerebral thrombosis. Clots form in arteries that already have been narrowed by a condition called atherosclerosis (hardening of the arteries).

Atherosclerosis causes fatty material to build up along the inner lining of the arteries so that they become narrower and the blood flowing through them becomes more likely to clot.

Lifestyle risk factors for atherosclerosis include high cholesterol, smoking, high blood pressure, diabetes, obesity and physical inactivity.

A partial clot that may form in the heart or the blood vessels of the neck which is carried in the bloodstream to the brain and gets lodged in an artery. This is a cerebral embolism.

Blockages that occur in the tiny blood vessels deep in the brain. This is a lacunar stroke.

 

2. Haemorrhagic stroke:

Up to 20% of strokes are caused by a bleed into the brain from a burst blood vessel. This is called a cerebral haemorrhage and causes the more serious kind of stroke.

It is often not obvious why someone should have suffered a stroke. Even though many people believe it to be a factor, stress is not a cause of stroke.

Prevention

Stroke

Every year, more than 10,000 people in Ireland have a stroke.

Stroke is the biggest cause of acquired disability and the third biggest cause of death in this country. Stroke can happen at any age. One third of strokes happen in people under sixty-five years of age.

 

Age, family history, background.

Some people are at greater risk for reasons beyond their control such as age and family history. Also, statistics show that people from Asian and African communities are more likely to have a stroke.

Some people are more at risk of having a stroke if they have certain medical conditions, such as atrial fibrillation. It is important that these conditions are carefully monitored and treated.

 

Lifestyle factors

Your risk of having a stroke is increased by certain things in your lifestyle which you can change, and which also increase your chances of having a heart attack.

These include: smoking, being overweight, high blood pressure, high cholesterol and diabetes.

 

Stress and stroke?

The link between stress and stroke is complex and not fully understood. If you feel stressed, your blood will produce more hormones.

Although useful in small amounts, over time too many of these hormones can damage your blood vessels and may lead to high blood pressure.

When life becomes pressurised, you are also more like likely to smoke more cigarettes, drink more caffeine, drink too much alcohol and be less physically active. All of these increase your risk of stroke.

The good news is that by making small changes to your lifestyle, such as stopping smoking and managing your weight, and by taking medications for certain conditions as directed by your doctor, you can reduce your risk of stroke.

 

How to reduce your risk factors?

To help get you on the right track, we’ve developed a range of articles with practical tips and expert advice on how to reduce your risk factors for Heart Disease and Stroke.

Simply go to our section: Ways To Live Life Better. A few minutes of reading could make all the difference to your heart health and overall well-being.

Diagnosis

Stroke

A stroke is a medical emergency so recognising the symptoms and accessing treatment immediately can be crucial.

A stroke causes damage to the brain. The effects depend on the part of the brain that is affected. But every stroke is different.

When you come to hospital after having a stroke you may be assessed in the Emergency Department. This physical assessment is essential to rule out other possible causes of your symptoms and ensure you are given the right emergency treatment.

 

The physical assessment will check:

 

  • What type of stroke you have had, the area of your brain that was damaged and how serious the damage is.
  • The condition of your heart and lungs
  • Problems you may have swallowing.

 

You may then need to have a number of other tests which should be carried out as soon as possible. The earlier your stroke is diagnosed the better chance you have of making a good recovery.

 

These other tests include:

Blood pressure test: High blood pressure is the most common cause of stroke. Your blood pressure will be checked immediately. You will receive medication if you need it.

  • ECG (electrocardiogram): Irregular heart rhythms can increase your risk of stroke. This test checks your heart for unusual rhythms.
  • Blood tests: Samples of blood are taken in order to check your cholesterol levels, your blood’s ability to clot and your blood sugar levels.
  • Brain scan or CAT scan (computerised resonance imaging): This is an x-ray of the brain. You should have a brain scan within 24 hours of having a stroke.
  • MRI scans (magnetic resonance imaging): give a very detailed picture of the brain. To do this test, you will be placed in a large tunnel-shaped scanner.
  • Carotid Doppler ultrasound: detects blockages in the carotid artery which may have caused the stroke. A Doppler probe is placed on the artery on your neck to check the blood flow.
  • Echocardiogram (Echo): a Doppler probe is moved over your chest to check the way your heart is working and to look for any problems.
  • Chest x-ray: this will help show the condition of your heart and lungs.
  • Videofluoroscopy Swallow Test: A further x-ray called a videofluoroscopy may be done if you continue to have difficulties swallowing. This x-ray tests what food and drink you can swallow safely so that food and liquids don’t get lodged in your windpipe and lungs.

Treatment

Stroke

Emergency treatment for stroke depends on whether the cause.

Treatment depends on whether the stroke is caused by a blockage in your artery (ischaemic stroke) or bleeding into your brain (haemorrhagic stroke).

Some ischaemic strokes can be treated by thrombolysis, a clot-busting drug aimed to dissolve the blood clot with powerful blood thinners.

This drug treatment is only effective if received within 4.5 hours of your stroke starting. This is why it is so important to get to hospital immediately because the more time passes the less effective it is.

However, thrombolysis is not suitable for everyone. Your doctor will check if it would be a good treatment for you.

You may also be given aspirin or other anti-platelet medicines to reduce the stickiness of your blood and stop clots forming.

With haemorrhagic stroke the emergency treatment focuses on controlling the bleeding and reducing the pressure it is causing in your brain.

Surgery also may be needed to remove the blood and repair the blood vessel to help reduce future risk.

 

What common disabilities can stroke cause?

Stroke affects people differently. The effects of stroke vary widely depending on what part of your brain has been injured and how much brain tissue is involved. The following effects are particularly common:

 

Weakness or hemiplegia

About 80% of people who survive a stroke will suffer paralysis on one side of the body. This can either be partial or complete depending on the seriousness of the stroke.

 

Paralysis

Paralysis is caused because of injury to the area of the brain that sends messages to the arms and legs. Sometimes this loss of power also affects one side of the face.

 

Your balance

This may also be affected making you likely to fall or to lean sideways in bed, or on a chair.

 

Loss of sensation on one side of the body

This can be more than just loss of feeling in the skin. It can mean that without looking you will not know how your arm or leg is positioned. You may also have difficulties knowing right from left and with judgment of depth and distance.

 

Swallowing

Swallowing difficulties affect about 50% of people who have a stroke. Liquids are more difficult to swallow than solid food.

 

Difficulties in communicating

You may experience aphasia (also known as dysphasia). This affects your ability to understand and use language.

There are two major communication problems after stroke:

 

  • Not being able to understand the spoken word.
  • Not being able to express words.

 

You may lose your ability to speak completely, but still understand everything that is said to you. If you meet someone affected by stroke you should not assume because they cannot speak that they cannot understand.

For other people who have had a stroke, it can almost make it seem like everyone else is speaking a foreign language. After a stroke you may be able to speak, but what you say may not always make sense. Your reading and writing abilities can also be affected.

 

Loss of intellectual or thinking ability

You may have problems with attention, concentration, working out problems and grasping new information. Memory problems usually relate to day-to-day events rather than long-term memories.

 

Loss of vision

You may lose half your field of vision where you can see everything on one side, but nothing on the other. If you have weakness of the left side of your body, you may find it difficult to see things on that side.

Often people are unaware of this problem and may be surprised to keep bumping into furniture and door frames.

 

Emotional changes

Emotional ups and downs can be caused either by the distress that comes from having a stroke, or changes that have happened in the brain.

Mood swings, caused by changes in the brain, are often experienced after stroke. Depression, anger, anxiety, sadness and loss of confidence are all common.

You may find it hard to control your emotions and may laugh or cry for no apparent reason.

 

The Recovery Process

Following the initial emergency treatment, subsequent care focuses on regaining your strength, recovering as much function as possible and returning to independent living.

The effects of stroke will depend on the part of your brain that has been damaged; how bad the injury is; and your general health when the stroke occurs.

 

Stroke unit

After a stroke you should be cared for in a specialist stroke unit. A stroke unit is a separate area of a hospital ward for stroke patients. It is staffed by a stroke team of doctors, nurses and therapists, who are experts in stroke.

 

Monitoring

Your brain needs time to heal so you must be closely monitored in the days and weeks after stroke as complications can occur. You may also have difficulties with swallowing, balancing and vision.

For some people the effects are mild and last a short time. Other strokes may cause more severe or lasting disability.

 

Rehabilitation

Once you are stable you will be assessed by a rehabilitation team. Rehabilitation should start soon after you are admitted to hospital and continue throughout your hospital stay.

The rehabilitation team includes Speech and Language Therapists, Occupational Therapists, Physiotherapists, Dieticians, Nurses, Psychologists and Social Workers. They work together to help you make the best recovery possible.

 

Gradual process and different for everyone

Recovery is usually a gradual process after stroke and can take many months as the brain needs time to heal.

Recovery is different for each person. Some people may recover and have only a slight disability. Other people may have more serious disabilities. In general, most recovery is made in the first year, but you can still make progress after this time.

Unfortunately, some people will not recover from a stroke. People who are dying as a result of a stroke should be given end-of-life care.

 

Ongoing Stroke Support

Stroke care and rehabilitation in Ireland is advancing by the day. Stroke Units are a vital part of this, as is following all your rehabilitation steps.

There are also many Stroke Support Groups all over Ireland for stroke sufferers and their family members, where you can talk to other people who have suffered a stroke and share advice.

See our Resources section for contact details and more information. And of course, you can always call our Heart & Stroke National Nurse Helpline with any questions or concerns.

Lastly, for more advice and insights into Stroke Rehabilitation please view our in-depth article here. It could help you make a huge difference in every aspect from day-to-day life to financial support.

Resources

Stroke

Read our resources for further information:

Step by Step through Stroke – View our guide for those affected by stroke and their carers.

What is a stroke and how to treat stroke? – View our leaflet that covers topics from causes to treatment and medical terms explained.

Preventing Stroke – View our leaflet above that talks you through lifestyle risks, family history risks, and ways to reduce your risks.

Stroke Rehabilitation – View our leaflet that covers stroke rehab from discharge to recovery and your stroke team, as well as support in your community and common physical problems. You’ll also find advice on dealing with day-to-day issues and a list of useful contacts.

Stroke Rehabilitation, how it can help you – Learn about each step in the rehabilitation process from occupational therapy to speech therapy and your support options. Find out what to expect, and how to make rehabilitation work best for you.

Why We Need To Act FAST – Take a moment to learn more about stroke and why we need to act F.A.S.T. You can also view the Act FAST adverts here too and hear about Martin’s recovery due to seeing the ad and his quick thinking.

Stroke Support Groups In Ireland – For more information and contact details for getting advice and support near you.

Ways To Live Life Better – View our range of articles on ways to improve your lifestyle and reduce risk factors ranging from alcohol, to healthy eating, and stopping smoking.

Real Life Stories – View real stories, lessons and advice from people who have survived stroke and heart conditions.

Symptoms