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Media, News & Topics on prevention, diagnosis & treatment of cardiovascular disease
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Preventing Stroke in People With Atrial Fibrillation

Preventing Stroke in People With Atrial Fibrillation | Heart and Vascular Health | Scoop.it
When blood does not flow smoothly, there is a chance that the blood can form clots. If a blood clot has formed in the heart, it can be carried by the bloodstream to other areas of the body (thromboembolism). This is dangerous because the clot can become wedged in a smaller blood vessel and decrease the flow of blood to the area that blood vessel supplies.

A blood clot that travels to the small blood vessels in the brain can decrease or block blood flow to the brain, causing injury to the brain (ischemic stroke).

The chance of forming blood clots is different from person to person. Atrial fibrillation is not the only factor that creates blood clots; some people may have other medical problems that can increase the chance of forming blood clots or having a stroke. Your doctor will consider your situation to decide whether you have a low or high risk of blood clots or stroke.
Seth Bilazarian, MD's insight:

Atrial fibrillation can increase the risk of thromboembolism and ischemic stroke. Treatment for atrial fibrillation might require anticoagulation, but each patient should be considered individually. The risk of stroke needs to be considered with other medical details, such as the risk of bleeding, to determine the best plan for each patient.

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Shyam Kumar Chaturvedi's curator insight, July 31, 2015 12:32 AM

Atrial fibrillation can increase the risk of thromboembolism and ischemic stroke. Treatment for atrial fibrillation might require anticoagulation, but each patient should be considered individually. The risk of stroke needs to be considered with other medical details, such as the risk of bleeding, to determine the best plan for each patient.

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Heart-Rhythm Monitoring for Evaluation of Cryptogenic Stroke

Heart-Rhythm Monitoring for Evaluation of Cryptogenic Stroke | Heart and Vascular Health | Scoop.it

Observational studies suggest that we often fail to detect paroxysmal atrial fibrillation as the cause of ischemic stroke. However, owing to the limitations of existing studies, guidelines have yet to endorse specific strategies for detecting atrial fibrillation in patients with a new stroke. The results of two studies published in this issue of the Journal indicate that prolonged monitoring of heart rhythm should now become part of the standard care of patients with cryptogenic stroke.leaving it unclear whether monitoring improves diagnosis as compared with routine follow-up. 

Seth Bilazarian, MD's insight:

Our patients want to avoid stroke because of the debilitating effects it can have on functional status and quality of life.  Efforts to prevent a second stroke are enthusiastically embraced by patients.

Cryptogenic is stroke that a cause cannot be determined (about 1/3 of strokes).  Treatment with anticoagulants in this patient population is not recommended UNLESS the cause of the stroke is from the common irregular heart rhythm atrial fibrillation (AF).  

On the other hand if atrial fibrillation is NOT detected treatment with aspirin or other anti-platelet drugs are used and these drugs are inferior to anticoagulants if AF is the cause.

Two studies in NEJM showed that prolonged monitoring (30 days or 6 months)  increased the detection of AF and allowed more patients to be started on anticoagulants for stroke prevention.

In the trial of 30 days of recording with an external (carried) monitor was 16.1%.

In the trial of the implanted recorder detection of AF was 

at 6 months 8.9%

at 12 months 12%

at 36 months 36%

 The strategy of prolonged monitoring with an external device  for 1 month or 6 months with an implanted device is an unresolved question and adoption of the small subcutaneous device pictured above, will be limited by its cost, until further studies showing stroke reduction can be completed justifying its cost.

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Stroke, an Animation & Telehealth ER evaluation

Stroke, an Animation & Telehealth ER evaluation | Heart and Vascular Health | Scoop.it
A description of what happens when a stroke occurs.
Seth Bilazarian, MD's insight:

Very good animation of the carotid artery and development of atherosclerosis and then thrombosis.  The feature following the animation is a real telehealth visit for a patient with a stroke in the setting of atrial fibrillation making a decision about whether to use thrombolytic treatment (tPA) for clot busting of the stroke causing clot.

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Researchers Compare Exercise, Drugs as Cardiovascular Treatments

Researchers Compare Exercise, Drugs as Cardiovascular Treatments | Heart and Vascular Health | Scoop.it

Structured exercise programs may be as effective, or even more useful, than medication to treat cardiovascular conditions. The authors evaluated and synthesized the results of 305 previous studies to compare the benefits of drug and exercise regimens on disease outcomes.  

After identifying four conditions for which exercise has been studied as a preventive technique—coronary heart disease, stroke, heart failure, and type-2 diabetes—Naci and Ioannidis compared the efficacy of drugs used to treat these conditions to previously-reported effects of exercise.

 They found that structured physical activity was more effective than drug use in the treatment and prevention of strokes, and equally effective in the secondary prevention of coronary heart disease and diabetes.  Diuretic drugs were more successful than exercise, however, in treating heart failure.

“[Our study] will trigger debate, which is really important,” said Naci. “In cases where we have evidence of exercise, exercise seems to do really well in comparison to drugs, but there are still a lot of instances where we don’t know how exercise fares against drugs.”

Seth Bilazarian, MD's insight:

Unfortuaneely this eithetr or approach is not best.  For all patients who needs drugs for management of high blood pressure or cholesterol problems or diabetes the question is not drugs or exercsie but should be drugs and exercise.

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Dr. KGM BIYABANI's comment, November 3, 2013 12:00 AM
TREATMENT REGIMENS ARE TO BE INDIVIDUALIZED ACCORDING TO THE PATIENT'S DISEASE AND THE TREATMENT REGIMEN OUTCOMES. ACCORDING TO THE ABOVE STUDY THERE SHOULDN'T BE AN "OR".; TREATMENT REGIMENS MAY INCLUDE MANY PREVENTIVE AS WELL AS CURATIVE THERAPIES, BOTH PHARMACOLOGICAL AND NON-PHARMACOLOGICAL. AT THE END PATIENT/PERSON MATTERS. THERE SHOULD BE "AND" instead of "OR". OF COURSE THERE IS NEVER A MAGIC BULLET IN HEALTHCARE;THAT'S WHY THERE SHOULDN'T BE AN "OR" AS DR. BILAZARIAN HAS SAID. AND I AGREE WITH ROBIN THOMAS ABOUT "THE MAGIC BULLET" PART ONLY.
Dr. KGM BIYABANI's curator insight, November 3, 2013 12:04 AM

TREATMENT REGIMENS ARE TO BE INDIVIDUALIZED ACCORDING TO THE PATIENT'S DISEASE AND THE TREATMENT REGIMEN OUTCOMES. ACCORDING TO THE ABOVE STUDY THERE SHOULDN'T BE AN "OR".; TREATMENT REGIMENS MAY INCLUDE MANY PREVENTIVE AS WELL AS CURATIVE THERAPIES, BOTH PHARMACOLOGICAL AND NON-PHARMACOLOGICAL. AT THE END PATIENT/PERSON MATTERS. THERE SHOULD BE "AND" instead of "OR". OF COURSE THERE IS NEVER A MAGIC BULLET IN HEALTHCARE;THAT'S WHY THERE SHOULDN'T BE AN "OR" AS DR. BILAZARIAN HAS SAID. AND I AGREE WITH ROBIN THOMAS ABOUT "THE MAGIC BULLET" PART ONLY.

Randy Randhawa, DC's curator insight, November 5, 2013 10:45 AM

Daily motivation, "structured exercise programs may be as effective, or even more useful, than medication to treat cardiovascular conditions."

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No clear answers on whether to close a "hole in the heart" (PFO) after a stroke

No clear answers on whether to close a "hole in the heart" (PFO) after a stroke | Heart and Vascular Health | Scoop.it

In approximately 30% of young survivors of stroke, no clear cause is identified despite a thorough evaluation. Patent foramen ovale ("hole in the heart") is found in about half of these patients, as compared with approximately 25% of the general population. Clinicians, then, often assume that the patent foramen ovale was the cause of the stroke, although it may be incidental in some patients. The most effective strategy for the prevention of stroke recurrence in such patients is uncertain, and some experts recommend closure of the patent foramen ovale to prevent future embolic events, although high-level data have been lacking.

Seth Bilazarian, MD's insight:

Key points

1.  Three trials: CLOSURE I, RESPECT  and PC Trial din not show a significantly lower rate of  stroke compared with medical therapy

2. Recurrent stroke rates in these trials were low in both mediacl and device arms and trended toward benefit of the device but did not reach stitistaical significance.

3.  These trials leave plenty for device skeptics and enthiuusiasts to continue to debate.

4. The device used in the RESPECT and PC Trial called Amplatzer had a good safety record.

5. RESPECT investigators are continuing to accrue data on the patients they enrolled and that other studies are ongoing.

6.  We are left for the moment to make decisions under conditions of uncertainty. Depending not only on the interpretation of the results, but also on the potential consequences of decisions.  The hard work of collaborative decision making between patients and the physicians that care for them will need to continue.

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Diagnosis of acute stroke by bad texting

Diagnosis of acute stroke by bad texting | Heart and Vascular Health | Scoop.it
Here's a new way to diagnose dyslexia by maladroit texting. New methods for #cHealth and #mHealth.
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Tomatoes for Stroke Prevention?

Tomatoes for Stroke Prevention? | Heart and Vascular Health | Scoop.it

My comment:  Another data point adding to the recommendation for 5 fruits and vegetables daily.  DON'T take some nutritional supplement - eat your veggies!

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Lycopene, which is found in high concentrations in tomatoes and tomato-based products, may lower stroke risk in men, researchers found. "Foods such as tomatoes, guava, watermelon, and grapefruit are good sources of lycopene,"  "When a tomato is cooked, the heat processing actually increases the levels of cis-lycopene, which is easily absorbed by the body."

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Sleep Apnea Association With Serious Cardiovascular Events

Sleep Apnea Association With Serious Cardiovascular Events | Heart and Vascular Health | Scoop.it

Take home message: Sleep Apnea stresses the heart and vessels because of the repetitive periods of low oxygen that occur dozens of times each night when the patient has apnea (stops breathing).  Recognition, diagnosis (with a sleep study) & treatment for this problem are very important for cardiovascular health. This meta-analysis syas there is a doubling of stroke risk in men.

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The relationship between obstructive sleep apnea (OSA) and cardiovascular events remains unclear.  Review to determine the incidence of cardiovascular events among patients with OSA showed associated with stroke in a meta-analysis of 5 studies (8435 participants), odds ratio (OR) 2.24; A significant association was seen in studies of men predominantly; OR, 2.87; 95% CI, 1.91–4.31, Data on women were sparse. In the overall analysis of 6 studies (8785 participants), OSA was nonsignificantly associated with ischemic heart disease (OR =1.56)

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New Blood Thinner: Xarelto for Atrial Fibrillation (AF) and Stroke Prevention

Xarelto (Rivaroxaban) is a new alternative for prevention of stroke for patients with atrial fibrillation. With its introduction, we now have the oldest option for patients, Coumadin (Warfarin) and another new anticoagulant treatment Pradaxa (Dabigatran) as options available to reuduce stroke (CVA) risk.  Drs Srivistava and Bilazarian discuss the newest entrant and review the data for patients on the series Matters of the Heart produced by Haverhill Community Television and Pentucket Cardiology.

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TIA for the Patient

TIA for the Patient | Heart and Vascular Health | Scoop.it

The definition of TIA is changing. Previously, TIA was defined as a focal cerebral ischemic event with symptoms lasting < 24 hours. As computed tomography and magnetic resonance imaging have become more widely used, up to one-third of patients with TIA have radiological evidence of acute infarction. Therefore, the definition of TIA is moving from time-based to tissue-based, as “a transient episode of neurological dysfunction caused by central nervous system ischemia without acute infarction.” Unilateral weakness and speech disturbances are the most common manifestations of TIA. Unilateral weakness (face, arm, or leg) and speech disturbance (aphasia or dysarthria) are seen in approximately 31%-54% and 25%-42% of TIAs, respectively.

Short-term risk of stroke increases after TIA. The risk of stroke in the days and months after TIA can be estimated using the ABCD2 score.

Seth Bilazarian, MD's insight:

TIA, sometimes called by patients "mini-strokes" ,are often warning signs before a stroke.  Evaluating how much risk there is of a completed stroke with permanent disability can be estimated using the ABCD2 score pictured.  Converting the score to the risk as seen in the figure can help match the level of intensity by patients & doctors to evaluate and treat the TIA, with the goal of reducing the stroke risk.

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Warning Signs of a Stroke

Warning Signs of a Stroke | Heart and Vascular Health | Scoop.it
SIGNS AND SYMPTOMS OF A STROKE? When the brain does not get enough blood flow, many different signs and symptoms can occur. The amount and type of symptoms depend on what part of the brain is involved. Some of the common signs of stroke include 

Asymmetry in the face or a droop on one side of the face

Weakness on one side of the body (such as an arm, leg, or both)

Numbness or unusual sensations on one side of the body

Trouble speaking (speech is slurred; cannot repeat a simple phrase)

WHAT SHOULD I DO IF I NOTICE WARNING SIGNS? Time is the most important factor if you think you are having a stroke. The faster you can get to a hospital, the better your chances of recovery. Therefore, you should call the paramedics right away if you have any of the above warning signs—do not “wait it out” to see if the symptoms get better on their own. The reason that time is very important is that for some strokes, a medication that dissolves blood clots can be given through the bloodstream as treatment. This medication only works during the first few hours after a stroke. After that it is no longer effective and can even cause harmful side effects. Therefore, it is very important, when possible, to record the exact time that you or someone around you first noticed symptoms and the time that you were last well without symptoms. 
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Dental Prophylaxis Protective to Ischemic Stroke

Dental Prophylaxis Protective to Ischemic Stroke | Heart and Vascular Health | Scoop.it

 Correlation has been found between periodontal disease (PD) and stroke. This study was conducted to investigate whether dental prophylaxis and periodontal treatment reduce the incidence of ischemic stroke.

Stroke rate of non-PD subjects was 0.32%/year. In the PD group, subjects who received dental prophylaxis had the lowest stroke IR (0.14%/year); subjects with intensive treatment or tooth extraction had a higher stroke IR (0.39%/year); and subjects without PD treatment had the highest stroke IR (0.48%/year; P<0.001).

Maintaining periodontal health by receiving dental prophylaxis and PD treatment can help reduce the incidence of ischemic stroke.

Seth Bilazarian, MD's insight:

The results of this study show that periodontal disease increases the incidence of ischemic stroke, especially among the younger population. Because it can be prevented and treated with improved oral hygiene, those who already have periodontal should seek treatment to alleviate tissue inflammation and thereby reduce the incidence of ischemic stroke.

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What to Know – and Do! – About Stroke

What to Know – and Do! – About Stroke | Heart and Vascular Health | Scoop.it
A stroke, sometimes called a “brain attack,” occurs when blood flow to the brain is interrupted. When a stroke occurs, brain cells in the immediate area begin to die because they stop getting the oxygen and nutrients they need to function.
What are the symptoms of a stroke?—

The symptoms of stroke are distinctive because they happen quickly—thus the origin of the name "stroke."

Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body)Sudden confusion, trouble speaking, or understanding speechSudden trouble seeing in one or both eyesSudden trouble walking, dizziness, loss of balance or coordinationSudden severe headache with no known cause
Seth Bilazarian, MD's insight:

Good basic information from NIH MedlinePlus magazine everyone should know (called AHA "give me 5").  Knowing these stroke symptoms and seeking early treatment can be life saving.  Faster treatment reduces the likelihood and severity of disability after stroke.

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Melissa L Faraias's curator insight, December 15, 2014 10:24 PM

Some useful information about a stroke.

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Cut Salt, Save 500,000 U.S. Lives Over a Decade, Study Finds

Cut Salt, Save 500,000 U.S. Lives Over a Decade, Study Finds | Heart and Vascular Health | Scoop.it

Reducing salt in Americans' diets would save hundreds of thousands of lives over 10 years, according to a new study.

Excess salt, the primary source of sodium, contributes to high blood pressure and cardiovascular disease, the leading killer in the United States.

Immediately reducing people's salt consumption from current levels to the upper limit of the U.S. government guideline -- 2,300 milligrams a day -- would save 500,000 to 850,000 lives over the next decade, largely by reducing heart attacks and strokes, the study found.

Gradually reducing sodium levels in processed or restaurant foods by 4 percent a year for 10 years would still save 280,000 to 500,000 lives over a decade, the researchers concluded.

The average American consumes about 3,500 mg per day, and men tend to ingest much more than that, according to the study, which was published Feb. 11 in the journalHypertension.

Seth Bilazarian, MD's insight:

Saving 50,000 lives per year is pretty significant since there would also be a reduction in people living with diseases like stroke and heart attack and the associated disabilities.

To put this in perspective in the current debate about guns.

Guns are responsible for roughly 30,000 deaths a year in America; more than half of those deaths are suicides. In 2010, 606 people, 62 of them children younger than 15, died in accidental shootings.

from Atlantic http://goo.gl/itytZ ;

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Can You Do Too Much to Prevent a Stroke?

Can You Do Too Much to Prevent a Stroke? | Heart and Vascular Health | Scoop.it
Too many people who are free of symptoms associated with stroke are undergoing surgery to clear carotid arteries, or are having stents inserted, than is justified by available evidence, experts say.

Stroke is the fourth leading cause of death among Americans, and a much larger contributor to chronic disability and health care costs than this ranking suggests. There’s no question that preventing strokes is important. But a big question is how best to do so and in whom.

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It's official: New Oral Antithrombotic Agents in Nonvalvular AF now in guidelines

It's official: New Oral Antithrombotic Agents in Nonvalvular AF now in guidelines | Heart and Vascular Health | Scoop.it

The new oral anticoagulants (NOAC): dabigatran (Pradaxa) and rivaroxaban (Xarelto), both FDA approved, and apixaban (Eliquis), which has not been approved, can all be considered for stroke prevention in nonvalvular atrial fibrillation, a science advisory from AHA/ ASA stated.

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Energy drinks: a trigger for heart attacks and stroke?

Energy drinks: a trigger for heart attacks and stroke? | Heart and Vascular Health | Scoop.it

Energy drink consumption has grown exponentially over the past 5 - 10 years. Sales are increasing at double the rate of total carbonated beverage sales.

The drinks are primarily targeted at youth and young adult market with aggressive advertising and marketing. And the potential medical complications of ingesting such drinks are becoming apparent, to both cardiologists and other health specialists.

The combined levels of caffeine in these energy drinks are much higher than a standard cup of coffee. And adverse events and complications from energy drinks largely arise from their caffeine content.

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