Chapter-9
Preventing Adult Illnesses and Deaths
The Top 10 Causes of Death
Ischemic heart disease, stroke, lower respiratory infections and chronic obstructive pulmonary (lung) disease (COPD) have remained the top major killers during the past decade (2005-2015).
Heart attack, Stroke and High Blood Pressure
Coronary Artery Disease (CAD) or heart attack, stroke and high blood pressure are interrelated. Many of the risk factors and the preventive measures are common to all three of them.
Coronary Artery Disease (CAD) (Heart Attack)
Heart attack (CAD) is the most common type of heart disease. It is the most common cause of death in both developed and developing countries. CAD is caused by a plaque buildup in the wall of the arteries (blood vessels) that supply blood to the heart, is made up of cholesterol deposits. Plaque buildup causes the inside of the arteries to narrow over time. The process is called atherosclerosis and it starts in our childhood. And it progresses until we die.
Narrowed artery walls can make it harder for blood to flow through your body. When your heart muscle doesn’t get enough blood, you may have chest pain or discomfort, called angina. Angina is the most common symptom of heart attack.
Over time, CAD can weaken the heart muscle. This may lead to heart failure, a serious condition where the heart can’t pump blood the way that it should. An irregular heartbeat, or arrhythmia, also can develop.
A heart attack, also called the myocardial infection (MI), occurs when a section of the heart muscle dies or gets damaged because of reduced blood supply. CAD is the main cause of heart attack. A less common cause is a severe spasm of an artery that supplies blood to the heart (coronary artery). Sudden cardiac arrest – the sudden stopping of the heart – occurs when the heart stops working completely –unless treated, the person will die within minutes.
Inflammation appears to play an important role in altering the cholesterol and promoting the process of atherosclerosis. Complications resulting from atherosclerosis – hypertension, heart attack and stoke are the leading cause of illness, disability and death, worldwide.
Risk Factors for Heart Attack
Factors which you have no control:
- Age 45 for man
55 for women
- Family History
If your father or brother was diagnosed with heart disease before age 55 or mother or sister before 65.
Following are the risk factors you can do something about:
- Unfavorable cholesterol profile. High bad cholesterol (LDL) 100, and Low HDL (good cholesterol)
- High blood pressure (Normal 120/80)
- Smoking, including second hand smoke.
- Obesity
- Lack of physical activity
- Excess alcohol consumption – leads to high blood pressure and bad cholesterol.
Symptoms of Heart Attack
- Discomfort in the center of the chest lasting more than few minutes or that goes away but comes back. Many people confuse it with indigestion.
- Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
- Shortness of breath with or without discomfort.
- Breaking out in cold sweat.
- Sensation of vomiting (nausea).
- Light headedness
If in doubt, do not procrastinate; get it checked by a doctor or hospital. It may save our life.
Diagnosing CAD
To find out your risk for CAD, your health care team may measure your blood pressure, cholesterol and sugar levels. Being overweight, physical inactivity, unhealthy eating, and smoking tobacco are risk factors for CAD. A family history of heart disease also increases your risk for CAD. If you’re at high risk for heart disease or already have symptoms, your doctor can use several tests to diagnose CAD.
Test What it does
| ECD or EKG
(electrocardiogram) |
Measures the electrical activity, rate, and regularity of your heartbeat.
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| Echocardiogram | Uses ultrasound (special sound wave) to create a picture of the heart
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| Exercise stress test | Measures your heart rate while you walk on a treadmill. This helps to determine how well your heart is working when it has to pump more blood.
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| Chest X-ray | Uses x-rays to create a picture of the heart, lungs, and other organs in the chest.
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| Cardiac catheterization | Checks the inside of our arteries for blockage by inserting a thin, flexible tube through an artery in the groin, arm, or neck to reach the heart. Health care professionals can measure blood pressure within the heart and the strength of blood flow through the heart’s chambers as well as collect blood samples from the heart or inject dye into the arteries of the heart (coronary arteries).
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| Coronary angiogram | Monitors blockage and flow of blood through the coronary arteries. Uses X-rays to detect dye injected via cardiac catheterization. |
Prevention
You cannot do anything about your family history or genetic, but you can take the following steps to prevent heart attack.
- Stop smoking if you smoke.
- Lose weight if you are overweight.
- Control your blood sugar (if diabetic) and cholesterol levels.
- Control your blood pressure.
- Consume a heart-healthy diet.
- Get regular exercise.
- Eat oily fish (mackerel, salmon) at least twice a week or take fish oil.
- Take an aspirin (81 mg) everyday if recommended by your doctor. Aspirin can cause stomach bleed.
- If you already have angina (chest pain) carry a fresh batch of Nitroglycerine tablets with you all the times.
Warning
If your chest pain lasts longer than few minutes and cannot be relieved by rest or by taking angina medicine, you may be having or about to have a heart attack. Call an ambulance; chew a 325 mg. aspirin tablet (adult aspirin).
STROKE
Stroke is the second leading cause of death. To understand stroke, it helps to understand something about the brain. The brain controls our movements; stores our memories; and is the source of our thoughts, emotions, and language. The brain also controls many functions of the body – movements, breathing and digestion. To work properly, our brain needs oxygen. Although our brain makes up only 2% of our body weight, it uses 20% of the oxygen we breathe. Our arteries (Cerebral arteries) deliver oxygen-rich blood to all parts of our brain.
What happens during at stroke?
If something happens to interrupt the flow of blood, brain cells start to die within minutes because they can’t get oxygen. This is called a stroke. Sudden bleeding in the brain also can cause stroke if it damages brain cells. A stroke can cause lasting brain damage, long-term disability or even death.
If brain cells die or damaged because of a stroke, symptoms of that damage start to show in parts of the body controlled by those brain cells.
Three Main Types of Stroke Are:
- Ischemic (ii) Hemorrhagic (iii) Transient ischemic or mini-stroke
Ischemic Stroke: (lack of blood supply) 85% of the strokes are ischemic strokes. In ischemic stroke, the artery that supplies oxygen-rich blood to the brain becomes blocked. Blood clots often cause the blockages that lead to ischemic strokes.
Hemorrhagic Stroke:
A hemorrhagic stroke occurs when an artery in the brain leaks blood or ruptures (breaks open). The leaked blood puts too much pressure on brain cells, which damages them. High blood pressure and aneurysm (-balloon like bulges in an artery) can lead to the rupture of the artery and the bleeding into the brain. About 15% of the major strokes are hemorrhagic.
Transient Ischemic Attack (TIA):
A transient ischemic attack (TIA) is sometimes called a “mini-stroke”. It is different from the major types of stroke because blood flow to the brain is blocked only a short time-usually no more than 5 minutes.
Risk Factors for Stroke:
- History of previous strokes, major or “mini-stroke”.
- High blood pressure. There are often no symptoms.
- Cigarette smoking.
- Heart disease.
- High cholesterol – Atherosclerosis
- Sickle cell disease.
Know The Symptoms of a Stroke
- Sudden numbness or weakness on one side of the body-especially in the face, or in an arm or leg.
- Sudden severe headache (probably the worst you ever had).
- Sudden confusion or trouble speaking or understanding speech.
- Sudden vision problem one or both eyes.
- Abrupt difficulty in walking, dizziness, or balance or coordination.
If in doubt, (1) ask the person to smile. Both sides of the face should move equally. In stroke one side of the face does not move. (2) Ask the person to close his/her eyes and hold both arms out straight for 10 seconds. If one has a stroke, one arm drifts down. (3) Ask the person to say a common phrase. A person with stroke, slurs the words, or cannot speak at all.
If in doubt call medical emergency number or your doctor or hospital. Earlier the treatment for stroke, better the outcome. Time is of essence.
Prevention:
You can help prevent stroke by making healthy lifestyle choices. A healthy life style includes the following:
- Eating a healthy diet.
- Maintaining a healthy weight.
- Getting enough exercise.
- Not smoking.
- Limiting alcohol use
- Keeping your blood pressure within recommended range.
If you have already had a stroke or transient ischemic attack (TIA), also known as “mini-stroke”, your chances of having other strokes is higher.
During a stroke, every minute counts! Fast treatment can reduce the brain damage that stroke can cause.
High Blood Pressure
Blood pressure is the force of blood pushing against the walls of your arteries, which carry blood from your heart to other parts of your body. Blood Pressure normally rises and falls throughout the day. But if it stays high for a long time, it can damage your heart and lead to many health problems. High blood pressure raises your risk for heart disease and stroke. The only way to know if you have it is to measure your blood pressure. Then you can take steps to control it if it is too high. Some medical conditions can raise your risk for high blood pressure (like diabetes, kidney disease). If you have one of these conditions, you can take steps to control it and lower your risk.
Blood Pressure Levels
Normal – Systolic: Less than 120 mm Hg
Diastolic less than 80 mm Hg
At Risk (Pre-hypertension):
Systolic: 120-139 mm Hg
Diastolic: 80 – 89 mm Hg
High Systolic: 140 mm Hg
Diastolic: 90 mm Hg or higher
In pre-hypertension your blood pressure is slightly higher than normal, but it increases your risk of developing chronic or long-lasting high blood pressure. You should take steps to control it in the pre-hypertensive stage.
Effects of High Blood Pressure
High blood pressure can damage your health in many ways. It can seriously hurt important organs like your heart, brain and kidneys.
Heart: High blood pressure can harden your arteries, which decreases blood and oxygen to your heart and lead to heart disease. It can lead to angina, heart attack and heart failure.
The Brain
High blood pressure can burst or block arteries that supply blood and oxygen to the brain causing a stroke.
The Kidneys
Adults with diabetes, high blood pressure, or both have a higher risk of developing chronic kidney disease. Approximately 1 of 3 adults with diabetes and 1 of 5 adults with high blood pressure have chronic kidney disease. Chronic kidney disease ultimately leads to kidney failure, disability and death.
Risk Factors
- Diabetes: About 60% of the people who have diabetes also have high blood pressure.
- Age: your blood pressure rises as you get older.
- Family history.
- Unhealthy diet – Eating too much salt can increase blood pressure.
- Obesity –Obese people have higher bad cholesterol and triglyceride – leading to atherosclerosis.
- Physical Inactivity – Obesity – High B.P.
- Too much alcohol: Too much alcohol can raise blood pressure.
Signs and Symptoms:
High blood pressure is called the “silent killer” because it often has no warning signs and symptoms, and many people do not know that they have it.
Rarely, high blood pressure can cause symptoms like headaches or vomiting (late stage). There is only one way to know whether you have high blood pressure – have your doctor or nurse measure it. Measuring is quick and painless. Once you are taught how to do it, you can measure it at home.
Preventing High Blood Pressure:
By living a healthy lifestyle, you can keep your blood pressure in a healthy range and lower your risk for heart disease and stroke. A healthy lifestyle includes:
- Eating a healthy diet.
- Maintaining a healthy weight.
- Getting enough physical activity.
- Not smoking.
- Limiting alcohol use.
- Keeping your blood sugar under control.
Saheb Sahu, M.D., F.A.A.P., MPH.