Podcast Summary

Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. My name is Dr Warrick Bishop and I'd like to welcome you to my podcast station, my videocast station and the Healthy Heart Network. I've been asked by someone a question and I'd like to address that today. It's about heart attacks and stroke. Are there common factors involved in these two different processes? Well, I'm going to start off by asking what is a heart attack and what is a stroke? Well, a heart attack is when one of the blood vessels supplying the muscle of the heart is suddenly blocked. And that sudden blockage comes from a rupture of a cholesterol plaque within that artery. That rupture then leads to sudden closure of the blood vessel and then lack of blood flow beyond, with the consequence of heart muscle being damaged. That's a heart attack. A stroke is a lack of blood flow to a part of the brain. That can occur through exactly the same process as I just described that occurs in the coronary arteries. So a plaque in one of the great vessels of the neck may rupture, a clot may form and that clot may break off, go to a tributary within the brain and block the artery. That's called a stroke. an ischemic stroke or a stroke that stops blood getting to the brain we can also get strokes where a blood vessel in the brain can rupture and bleed into the surrounding tissues this is destructive this is called a hemorrhagic or bleeding into the brain stroke this is a big problem the last type of stroke is when the heart can be out of rhythm with a condition called atrial fibrillation and a clot can form within the heart, break off from the heart and go to the brain and that clot, bit of thrombus can close or block off a blood vessel again giving rise to a stroke. Well we now know what a heart attack is and we now know what a stroke is. I've talked about plaque in the arteries for the heart but also the great vessels for stroke. A ruptured blood vessel can bleed into the brain and for stroke, a clot within the heart can break off and go to the brain. So several different mechanisms. The important thing to realise is that for all these conditions, both heart attack and stroke, age is the single most important risk factor that we can't modify. After that, then we're very interested in blood pressure and cholesterol because once we start to modify blood pressure and cholesterol we can start to have an impact on the wear and tear of the arteries and the wear and tear on the heart. By lowering blood pressure and lowering cholesterol we can alter firstly the development of plaque in arteries but by lowering blood pressure we can reduce the risk of bleeding to the brain. Importantly by lowering blood pressure we can reduce the stress and strain on the heart. and reduce the risk of development of atrial fibrillation. So blood pressure becomes central to preventing heart attack and stroke from all its causes. So what do we do about that? Well my strong recommendation is to lock in with your local doctor. Go and get a risk assessment tool done. They will input your age, your sex, your cholesterol levels, your blood pressure levels. your diabetic status, smoking status and features of your heart into a risk calculator and let you know what your risk is such that if there is a problem treatment can be started well before a stroke or a heart attack occurs. One of my own interests is adding to that risk assessment by adding either imaging of the heart or imaging of the carotids to the equation to bring more precision to exactly what we're dealing with. If we're able to get people on blood pressure therapy, cholesterol therapy and aspirin well before they have an event then we can markedly reduce the likelihood of them having heart attack or stroke. There is no question that Prevention is better than cure. You don't want to wait until you've had a heart attack or a stroke to then be trying to put these strategies in place. You want to be proactive. Remember we're going to be dealing with plaque, so that's a blood pressure, cholesterol and aspirin question mark. Plaque for stroke in the major vessels in the neck, but also for stroke we want to keep blood pressure down because it will reduce the risk of a hemorrhagic stroke or bleeding into the brain and also we want to keep blood pressure down because it reduces progression to atrial fibrillation which is a condition where clot may form in the heart, break off and go to the brain causing a stroke. So please keep in close contact with your general practitioner please. Keep a close eye on your blood pressure. You really do want to keep it low. Please get your cholesterol checked. Please get your risk assessments checked. Please talk to your GP about whether you're a candidate for aspirin or not. And my suggestion would be you may well want to have the conversation about whether further imaging is important in your particular situation. Heart attack and stroke. My strong, strong recommendation is that we try and prevent it. not try and reduce risks once it's occurred. I encourage you to be proactive about your own health and seek support to get the information you need to make your best future decisions. I hope you found that an interesting insight into stroke and heart attack. If you have any queries or questions, please drop us a note. If you have any suggestions for future podcasts like this one was, a suggestion from one of our listeners, then please... let us know. I would of course like to wish you the very best and until next time, please don't die from a heart attack. Goodbye. You have been listening to another podcast from Dr. Warrick. Visit his website at drWarrickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.