Amid research seeking to quash debate about statin protection and efficacy, there is doubt. Is statin protection as debatable as some reports say, or is the controversy behind this category of medicinal products actually harming more people than the drug itself? We’ll find out.
Cholesterol is important for keeping the body working. However, having high levels of “poor cholesterol,” called low-density lipoprotein (LDL), can cause fatty deposits in the arteries to build up in the blood. Such buildup gradually results in narrowing and hardening of the arteries (a disorder known as atherosclerosis), which leads to a greater risk of heart attack and stroke.
Statins are a widely used drug that helps reduce unhealthy LDL cholesterol levels to minimize the cardiovascular disease risks.
US-approved statin forms include atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, simvastatin, and pitavastatin. They all function in a similar way by blocking the enzyme that produces cholesterol in the liver-HMG-CoA reductase.
Cardiac disease is the primary cause of death in the United States. Nearly 801,000 people died in the world in 2013 from a stroke, heart attack or other cardiovascular diseases.
Landmark studies exploring prevention of cardiovascular disease
Studies by Landmark investigated the use of statins in secondary cardiovascular disease prevention.
The Scandinavian Simvastatin Survival Research (4S) studied 4,444 people who had previously had a high cholesterol and heart attack. Simvastatin was found to reduce total cholesterol by 25 percent and LDL cholesterol by 35 per cent after a follow-up duration of nearly 5.5 years. Was encountered few adverse effects.
In the placebo party, the group taking simvastatin had 256 deaths (12 percent) compared to 182 (8 per cent). Simvastatin effectively reduced the probability of death by about one third. The 4S study concluded that “long-term simvastatin therapy is effective” in people with cardiovascular disease and improved survival.
The study of Cholesterol and Recurrent Events (CARE) analyzed 4,159 people with coronary heart disease and mean cholesterol levels to investigate the impact of reducing LDL levels on coronary events occurring.
Reducing the levels of LDL cholesterol from high to low with pravastatin significantly decreased the amount of repeated coronary accidents compared with placebo. Pravastatin lowered hdl cholesterol by 20 percent and LDL cholesterol by 28 per cent during the 5-year follow-up.
Individuals treated with pravastatin were 24% less likely to die from coronary heart disease or non-fatal heart attack, and the risk of stroke decreased by 31%. The CARE study found that pravastatin therapy reduces the risk of cardiovascular disease in people with a history of heart attack.
The research Long-Term Intervention in Ischemic Disease (LIPID) with Pravastatin studied 9,014 people with a history of heart failure and a wide range of cholesterol levels. The researchers aimed at evaluating the impact of pravastatin on cardiovascular disease death.
Pravastatin lowered total cholesterol by 18 percent and LDL cholesterol by 25 percent more than the placebo community during the first 5 years of follow-up. Individuals in the pravastatin category had 24 percent lower risk of death from coronary heart disease or non-fatal heart failure, 29 percent lower risk of heart attack, and 19 percent lower risk of stroke.
The LIPID study concluded that pravastatin is associated with a reduction in coronary heart disease mortality and total death in individuals who had never had a heart attack.
Treatment guidelines to decrease high blood cholesterol
A strong link between reducing LDL cholesterol with statins and decreasing cardiovascular risk has been consistently demonstrated in the trials. What the uproar, then?
While the body of evidence testing statins has grown, so have the drug’s indications. Guidelines published in 2013 by the American Cardiology College (ACC) and the American Heart Association (AHA) indicated that statin therapy can be beneficial to individuals in the following four groups:
- people with cardiovascular disease
- people who have high LDL cholesterol levels of 190 milligrams per deciliter or higher
- people aged 40 to 75 years with diabetes and LDL levels of 70-189 milligrams per deciliter
- people aged 40 to 75 years without diabetes, but with LDL cholesterol levels of 70-189 milligrams per deciliter and a predicted 10-year risk of cardiovascular disease of 7.5
Experts challenged the recommendations for 2013, claiming that a threshold of 7.5 per cent seemed too small. In 2015 two study teams reviewed this threshold and reported their results in the American Medical Association Journal.
The first study, led by Dr. Udo Hoffmann at Massachusetts General Hospital and Harvard Medical School – both in Boston – found that the 2013 guidelines were more effective in recognizing individuals at higher risk for cardiovascular disease compared with the 2004 guidelines. They predicted that between 41,000 and 63,000 cardiovascular accidents will be avoided over 10 years as compared with previous guidelines by following the 2013 guidelines.
The second paper, carried out by Drs. Ankur Pandya and Thomas A. Gaziano measured the cost-effectiveness of the 10-year threshold for cardiovascular disease at the Harvard T.H. Chan School of Public Health – based in Boston. The researchers concluded that a cost-effectiveness profile was appropriate for the risk level of 7.5 per cent or higher.
Due to the growth of the groups stated to benefit from statins, questions were raised about the pharmaceutical industry and the healthcare professionals who were prescribing. Alarm bells started to ring out that people were being over-medicated and placed at risk of harmful effects.
In addition, these concerns can be sparked by a misconception of clinical trials and how they work. Statins are among the drugs best tested in randomized clinical trials. These were found to decrease the number of strokes and heart attacks, even in people with normal levels of cholesterol, and prolong life.
In addition, statins have been shown to enhance cardiovascular health and reduce an increased risk of heart failure in people, particularly though they have already made improvements in their diet and exercise rates.
Are declines in cardiovascular disease death rates due to statin use?
While a heart-healthy diet, daily physical activity, and maintaining a healthy weight are all components that can help to lower cholesterol and minimize the risk of heart disease and stroke, certain variables – such as genetics – can not be affected. Changes in lifestyle alone are not enough for reducing cholesterol in certain individuals.
The 2013 ACC / AHA recommendations are focused on a broad and reliable collection of evidence demonstrating the efficacy and safety of using statins to lower LDL and minimize the risk of cardiovascular disease.
In addition, subsequent advisory committees that established recommendations – such as the Consensus Recommendations on Cardiovascular Disease Prevention 2014 for the Joint British Societies, the 2014 Veterans Affairs and Defense Department Recommendations on Dyslipidemia Treatment, and the 2016 U.S. Preventive Services Task Force recommendations for cardiovascular disease prevention – both have used equivalent systematic methods to review evidence, resulting in similar recommendations for treatment, thereby further supporting the ACC / AHA guidelines.
Statin use rose from 18 percent to 26 percent between 2003 and 2012. By 2011-2012, statins were used by about 93 per cent of adults taking a lower cholesterol drug. Persons with elevated blood cholesterol levels fell from 18.3 percent to 12.9 percent between 1999 and 2012. Could the decrease in blood cholesterol levels be down to an rise in statin use?
According to a report published in the Journal of the American Medical Association, heart disease deaths dropped by 68 per cent from 1969 to 2013, and stroke deaths were 77 per cent lower.
There may be a link between the increase in statin use and the decline in cardiovascular disease related deaths. However, the gains made may be due to “the cumulative impact of improved prevention, diagnosis, and care,” says Wayne D. Rosamond, Ph.D., professor of epidemiology at Chapel Hill University of North Carolina.
Efforts that can play a role in decreasing death rates include stopping smoking, improving emergency response to heart disease, improving heart therapy and procedures, advancing medical research, legislation to create healthy environments, and growing public understanding of a healthier lifestyle.
Adverse effects of statins
The notion of a “net ASCVD risk-reduction benefit” was key to the ACC / AHA response to the 2013 recommendations – asking whether the probability of avoiding a significant cardiovascular accident or death is greater than the chance that the drug treatment could cause a severe adverse event.
Statins are commonly seen as healthy and well tolerated. For certain cases, however, statins may have adverse effects, as with any drug.
The most frequently recorded symptom is muscle aches which cramps, and may occur in 5 percent of individuals. In this case it could be given a particular statin or lower dose which is best tolerated. Statins also raise the likelihood that a small number of people develop type 2 diabetes.
The U.S. Food and Drug Administration (FDA) is recommending that statins for pregnant women are not recommended.
Recent study by Imperial College London’s National Heart and Lung Institute – in the United Kingdom – shows that individuals will not show an rise in muscle issues if they are unaware they are taking statins.
The study compared adverse effects recorded during randomized controlled trials (where the patient is unaware of the placebo or medication being taken) and retrospective studies (where the patient is aware of the medication being taken). Studies found that individuals who knew they were taking statins were 41 percent more likely to experience muscle issues – a trend called the nocebo effect.
“We know the statins will avoid a significant number of heart attacks and strokes. We know there’s a slight increase in the risk of diabetes and there’s a very small increase in myopathy at high doses, but overall the benefits far outweigh the harms, “says Peter Sever, professor of clinical pharmacology and therapy at Imperial College London. “Wide-ranging reports of high statin sensitivity levels still discourage so many people from taking an affordable, effective and potentially life-saving drug.”
“There are people out there who are dying because they are not taking statins and the numbers are huge – the numbers are tens of thousands if not hundreds of thousands, and they are dying because of a nocebo effect, in my opinion.”
This research echoes a study published in the European Journal of Preventative Cardiology in 2014 which analyzed the results of 29 trials involving more than 80,000 individuals. The study concluded that statins had limited side effects and there were less adverse symptoms encountered by people taking statins than those taking placebo.
Benefits of statins outweigh concerns about side effects
A 2016 study published in The Lancet states the side effects of taking statins are widely misunderstood, and the medications are safe and reliable. The study concluded that statin advantages outweigh the risks of an adverse reaction.
In 2015, researchers from the Centers for Disease Control and Prevention (CDC) analyzed results from the 2005-2012 National Health and Nutrition Examination Surveys and found that they were not taken by almost half of the people eligible for cholesterol-lowering medicines.
Statins for use in other circumstances have been investigated. Recent work suggests that statins can minimize 15 to 25 percent risk of venous thromboembolism and 12 to 15 percent risk of Alzheimer’s disease.
Mounting evidence appears to reverse the controversy surrounding statins and seeks to convince physicians and patients that the dangers of not taking statins – heart attack or stroke – greatly outweigh the fears regarding the drug-related side effects. Serious side effects are relatively uncommon. Study authors conclude that “significant misrepresentations of the evidence for its health” have undermined the substantial proven benefits of statins.
Evidence suggests that the statins are safe and efficient at population level. When you have a history of heart disease or stroke, you would possibly receive a statin prescribed for cholesterol levels without thought. In those with no known cardiovascular disease, a physician can use a validated risk Heart Disease to determine the 10-year and lifetime risk of heart attack and stroke.
Changes in lifestyle – including avoidance of smoking, eating a balanced diet and engaging in daily physical activity – may help avoid or delay cardiovascular disease.
Until beginning statin therapy, it is necessary to discuss with your doctor the possible benefits, costs, program tracking and other risk factors management.
Symptoms, causes, and treatment of transient ischemic attack (TIA)
A transient ischemic attack (TIA), also known as a ministroke, happens when the brain’s blood supply is interrupted for a short period of time.
Although the diminished blood flow normally only lasts 5 minutes, a TIA is still a medical emergency. It could be a precursor to a massive stroke.
Because the symptoms of a TIA resolve fast, many people do not seek medical care. However, according to the Centers for Disease Control and Prevention (CDC), more than one-third of people who don’t get treatment for a TIA will have a severe stroke within a year.
According to statistics, 20% of persons who have a TIA will have a stroke within three months, and half of these will happen within two days of the TIA.
Knowing the signs and symptoms of a TIA and seeking care as soon as possible can help you avoid a more serious and perhaps life-threatening incident.
In this article, you’ll learn more about what a TIA entails and what to do if one arises.
What is a TIA?
A transient ischemic attack (TIA) has symptoms that are similar to those of a stroke, but it causes only a few minutes. The decreased blood flow normally only lasts a few seconds, but the symptoms can last for several minutes. They can last for a few hours on rare occasions.
TIAs occur when a blood clot stops blood flow to the brain cells for a brief period of time, preventing oxygen from reaching the cells. The symptoms usually go away when the clot breaks up or moves on. These events do not stay long enough to cause brain cells permanently.
People should not dismiss a TIA since it could be an indication of a big stroke, according to the American Stroke Association.
According to statistics, TIAs afflict about 2% of the population in the United States.
When the supply of oxygen to the brain is interrupted, a TIA ensues. This could be as a result of:
- atherosclerosis, in which fatty deposits cause the arteries to become harder, thicker, narrower, and less flexible
- blood clots due to heart disease, cardiovascular disease, or an irregular heart rhythm
- blood clots due to a blood condition, such as sickle cell disease
- an embolism or blood clot that has traveled from elsewhere in the body
- an air bubble in the bloodstream
The symptoms of a TIA are determined by which area of the brain isn’t getting enough blood.
The acronym FAST (facial, arms, speech, time) might help people recall the symptoms to look for, just as it can with a severe stroke:
- F = face: The eye or mouth may droop on one side, and the person may be unable to smile properly.
- A = arms: Arm weakness or numbness might make it hard to raise one or both arms or keep them raised.
- S = speech: The person’s speech may be slurred and garbled.
- T = time: Someone should call the emergency services at once if a person has one or more of these symptoms.
The person may also have:
- numbness or weakness, especially on one side of the body
- sudden confusion
- difficulty understanding what others are talking about
- vision problems
- problems with coordination
- difficulty walking
- a very bad headache
- a loss of consciousness, in some cases
TIA symptoms are only present for a short time. They can last anywhere from a few minutes to several hours, and they normally go away after 24 hours.
However, if anyone experiences symptoms that could signal a TIA, they should seek medical care right away because a massive stroke could result.
The same variables that cause temporary blood flow insufficiency in a TIA can cause a stroke, which can result in irreversible brain damage owing to a longer-lasting blood flow deficit.
Conditions with symptoms that are similar
A TIA’s symptoms can be similar to those of other diseases, such as:
- multiple sclerosis
- a hemorrhagic stroke or ischemic stroke
- fainting due to low blood pressure
Even if the symptoms of the TIA have subsided, getting an accurate diagnosis can assist a person get the proper treatment to help minimise the risk of a future stroke.
- having a family history of stroke or TIA
- being 55 years or above
- being assigned male at birth
- being Black or Hispanic, compared with being non-Hispanic white
- having high blood pressure
- having cardiovascular disease
- smoking tobacco
- having diabetes
- getting low levels of exercise
- having high cholesterol levels
- eating a diet that is high in unhealthy fats and salt
- having high homocysteine levels
- having overweight or obesity
- having a type of heartbeat known as atrial fibrillation
Treatment options will be determined by the cause of the TIA. The parts that follow will go over some of the possibilities.
A doctor may recommend medicine to reduce the risk of a second blood clot and catastrophic stroke.
The treatment options will vary depending on the cause of the TIA, however they usually include:
- anti-platelet drugs to prevent clotting, such as include aspirin, ticlopidine (Ticlid), and clopidogrel (Plavix)
- anticoagulants such as warfarin (Coumadin) and heparin, which also help prevent clotting
- medications to manage high blood pressure, or hypertension
- drugs to help manage cholesterol levels
- medications to manage heart disease and regulate irregular heart rhythms
All of these medications can cause side effects and may interact with other medications.
As a result, people should tell their doctor about any other prescriptions they’re taking, including over-the-counter drugs, supplements, and herbal therapies.
If a person has negative side effects while taking a medication, they should consult a doctor. It’s possible that another option exists.
A doctor may propose surgery to remove a blockage or a portion of a damaged artery in some instances.
Preventive actions and lifestyle changes
A risk of lifestyle changes can help minimise your chances of having a TIA or stroke. These are some of them:
- avoiding or quitting smoking
- avoiding exposure to secondhand tobacco smoke
- eating a nutritious and varied diet, with plenty of fresh fruits and vegetables
- managing one’s intake of salt and unhealthy fats
- getting regular exercise
- avoiding the use of recreational drugs
- managing body weight, if appropriate
- following any treatment plan for heart disease, diabetes, or other conditions
Before making any major lifestyle changes, such as beginning a new workout plan, it is best to consult with a healthcare practitioner to determine the best course of action.
Anyone who has signs or symptoms of a TIA should seek medical help right away to figure out why it happened and how to avoid a recurrence or a more serious occurrence.
Symptoms can fade fast, and by the time the person sees a doctor, they may be gone. A witness who was present at the time, on the other hand, may be able to assist the individual in explaining the situation to the doctor.
The doctor will likely:
- ask what happened and ask about any ongoing symptoms
- ask how long the symptoms lasted for and how they affected the person
- consider the individual’s personal and family medical history
- carry out a neurological examination, which may include memory and coordination tests
If the doctor suspects the patient suffered a TIA, he or she may be referred to a neurologist for further evaluation.
The following are some examples of possible tests:
- blood tests to check blood pressure, cholesterol levels, and clotting ability
- an electrocardiogram to measure the electrical activity and rhythms of the heart
- an echocardiogram to check the pumping action of the heart
- a chest X-ray to help rule out other conditions
- a CT scan to reveal any signs of an aneurysm, bleeding, or changes to blood vessels in the brain
- an MRI scan to help identify damage to the brain
The doctor may also request that the patient wear a Holter monitor for a few days or weeks in order to track their heart rhythms over time.
The symptoms of a TIA can last anywhere from a few minutes to several hours. However, it is critical to seek medical help because a TIA can be a symptom of a massive stroke.
A TIA is marked by weakness and numbness on one side of the body, facial drooping on one side, and difficulty speaking. If you or someone you know is experiencing these symptoms, call 911 right away.
Following a TIA, lifestyle changes and the use of medicine to lower the risk of future blood clots are two choices for treatment.
What is an echocardiogram?
An echocardiogram is an ultrasound image of the heart. It can help doctors diagnose a range of heart problems.
Doctors use echocardiograms to help them diagnose heart problems, such as damaged cardiac tissue, chamber enlargement, stiffening of the heart muscle, blood clots in the heart, fluid around the heart, and damaged or poorly functioning heart valves.
In this article, we explain how doctors use echocardiograms, what to expect during the test, and how to interpret the results.
What is it?
Ultrasound waves are used in echocardiography to create a picture of the heart, which is referred to as an echocardiogram (echo).
It is a minimally invasive medical technique that emits no radiation and has few negative effects.
A doctor can see the following things during an echocardiogram:
- any blood clots in the heart
- areas of damaged or weak cardiac muscle tissue
- the size and thickness of the chambers
- how the valves of the heart are functioning
- problems affecting the pericardium, which is the fluid-filled sac around the heart
- causes of a stroke
- the direction of blood flow through the heart
What is the procedure?
Echocardiograms are simple, noninvasive procedures that require little preparation.
We’ll go over what to expect before, during, and after an echocardiography in the sections below.
The person does not need to prepare if the echocardiogram is taken from the outside of the body by a healthcare expert.
A doctor will advise people who are getting a transesophageal echocardiography to avoid eating or drinking anything for at least 6 hours before the procedure. Following the local anesthetic wears off, people can resume eating and drinking 1–2 hours after the echocardiography.
During the test
The transthoracic (external) echocardiography will be performed by a sonographer. Sonographers are medical practitioners who specialize in producing images and movies for diagnostic purposes utilizing ultrasound instruments.
The person getting the echocardiography will take off their clothes from the waist up throughout the procedure. If they want to be covered during the exam, they can wear a hospital gown.
The sonographer will then urge the patient to lie on their back or left side on a table. They may inject a saline solution or dye into the veins of the patient to make the heart seem more distinct on an echocardiogram.
The type of echocardiography determines the procedure. Consider the following example:
The sonographer will apply a gel to the chest if a doctor has ordered a transthoracic echocardiogram. After that, the sonographer will move the transducer across the chest to obtain various images of the heart.
The sonographer may ask someone to change positions or take or hold a deep breath throughout the examination. To gain a better view of the heart, they could press the transducer into the chest.
If a clinician wants more detailed or sharper images of the heart than a transthoracic echocardiogram can provide, they may perform a transesophageal echocardiogram.
The person may be given a small sedative to help relax the muscles in their throat and a topical anesthetic to block the gag reflex during a transesophageal echocardiogram.
A doctor will guide a small transducer on the end of a long tube down the throat and esophagus until it reaches the back of the heart once the sedative and local anesthetic have taken effect.
As the doctor moves the transducer around the esophagus, the sonographer will record images of the heart. After swallowing the probe, the user should not feel the transducer or tube in their esophagus.
After the test
After a transthoracic echocardiography, most people can resume their normal activities.
After a transesophageal echocardiography, people may be required to stay at the hospital or healthcare center for a few hours. They may have a sore throat at first, but it should go away within a day or two.
If you were given a sedative prior to the exam, you should not drive for many hours afterward.
What does it diagnose?
Echocardiograms allow doctors to see the size, structure, and activity of different parts of the heart.
This allows them to identify heart abnormalities, assess the need for additional tests, decide their next actions, and monitor changes and improvements.
Doctors may use this approach to examine for signs or symptoms that could indicate the following:
- Heart attack: The test can look for anomalies in the heart muscle tissue’s blood supply, as well as wall irregularities and blood flow, all of which can signal a heart attack.
- Blood clots (thrombus) or tumors: In a study published in 2021, echo was proven to be a viable alternative to cardiac magnetic resonance in detecting thrombosis. According to a 2020 study, it is also an important noninvasive method for detecting heart masses such as malignancies.
- Atherosclerosis and coronary artery disease (CAD): While an echo cannot detect artery blockages, narrowing and obstructed arteries can impair the heart’s ability to pump blood and disrupt the heart’s wall motion. This is more noticeable during times of stress, making a stress echo a useful diagnostic tool.
- Aortic aneurysm and aortic dissection: An echo can detect a wide, weaker aorta, as well as unruptured aneurysms and their size, as well as fibrosis and thrombus formation in the vessel.
- Cardiomyopathy: The test can determine the size and function of the heart and link it to factors such as wall thickness, weak heart muscle, leaky heart valves, heart failure, and high blood pressure.
- Pulmonary hypertension: The test can measure heart pressure, which can indicate the presence of pulmonary hypertension and aid doctors in determining the following steps in the diagnosis.
- Congenital heart disease: In newborns and early children, the test can detect congenital cardiac problems such as septal defects and holes.
- Heart valve disease: The test checks for leakage, constriction, infection, and blockage in heart valves, as well as irregular cardiac blood flow.
- Problems with the pericardium: The test can determine whether the pericardium (the sac that surrounds the heart) is inflamed (pericarditis) or has become filled with fluid or blood (pericardial effusion).
- Heart failure: It can detect cardiac muscle that is weak, stiff, or thickened, which can be a symptom of heart failure.
Doctors frequently utilize the test to determine the cause of an abnormal electrical heart test, known as an electrocardiogram (EKG).
The method is also used to track how effectively the heart responds to various heart treatments, such as heart failure, drugs, prosthetic valves, and pacemakers.
If a doctor suspects a patient has cardiac abnormalities, an echocardiography will be ordered. The following are signs and symptoms that could suggest a cardiac condition:
- an irregular heartbeat (arrhythmia)
- shortness of breath
- high or low blood pressure
- leg swelling
- abnormal EKG results
- unusual sounds between heartbeats, known as heart murmurs
Types of echocardiogram
Different types of echocardiograms are available, all of which use high-frequency sound waves. The following are some of the most frequent types.
The most common form of echocardiography is the transthoracic echocardiogram.
An ultrasound wand called a transducer is placed on the outside of the chest, near the heart, for this test. Sound waves are sent through the chest and into the heart via the device.
Sound waves move more easily when a gel is applied to the chest. These waves bounce off the heart and appear on a screen as images of the heart’s architecture.
A thinner transducer attached to the end of a lengthy tube is used in a transesophageal echocardiogram. The tube will be swallowed and inserted into the esophagus, which connects the mouth to the stomach and runs behind the heart.
Because it gives a “close up” view of the heart, this type of echocardiography produces more detailed images of the heart than the typical transthoracic echocardiogram.
Doppler ultrasounds are used by doctors to check blood flow. They accomplish this by producing sound waves at specified frequencies and observing how the waves bounce off and return to the transducer.
Color doppler ultrasounds can be used by doctors to map the direction and velocity of blood flow in the heart. The blood flowing toward the transducer shows red, while the blood flowing away appears blue. It can also tell you how bad the blockages are.
A doppler ultrasound can detect issues with valves or holes in the heart’s walls, as well as let doctors examine how blood flows through it.
A detailed 3D image of the heart is created through a 3D echocardiography. 3D echocardiograms can be used by doctors to:
- plan heart valve or structural interventional surgery
- image complex structures within the heart
- assess valve functionality in people who have heart failure
- assess the function of the heart in 3D
- diagnose heart problems in infants and children
A doctor can order an echocardiogram as part of a stress test. A stress test involves physical exercise, such as walking, jogging on a treadmill, or riding a bike.
During the test, the doctor will keep track of your heart rate, blood pressure, and electrical activity in your heart.
Before and after the activity, a sonographer will do a transthoracic echocardiogram.
Stress tests are used by doctors to diagnose:
- heart failure
- problems affecting the heart valves
- ischemic heart disease
- coronary heart disease
Point-of-care (POC) echocardiogram
A POC echocardiogram is a type of echocardiogram that can be performed at a patient’s bedside by a clinician. These can assist a doctor in answering specific inquiries about possible differential diagnoses.
Limited and focused POC echo are the two types of POC echo.
A limited echocardiogram aids a clinician in determining the cause and repercussions of a heart injury. A focused echo is used by a doctor to assist narrow down the list of other possible diagnoses or to answer a specific query.
With each heartbeat, a POC echocardiogram can determine how well the left or right ventricles pump blood.
A fetal echocardiogram allows doctors to see the heart of an unborn baby. This check is normally done between 18 and 22 weeks of pregnancy. Because echocardiograms do not involve radiation, they are safe for both the mother and the infant.
Interpreting the results
The echocardiographic images will be sent to the doctor who requested the test by the sonographer after the exam. The doctor will examine the photos for indicators of cardiac disease, such as:
- abnormal chamber size
- poorly functioning valves
- chamber size
- masses in the heart, such as blood clots or tumors
- damaged heart muscle tissue
- pumping function of the heart
- thick or thin ventricle walls
What can it miss?
Echocardiograms are very useful in detecting structural heart abnormalities. They may, however, not be the ideal way to check the coronary arteries.
Blockages can cause the structure of the heart. Changes in cardiac function, weak muscles, or thinner heart walls are frequently detected by doctors, prompting them to order additional tests such as a coronary angiogram.
Echocardiograms cannot detect conduction disorders or electrical difficulties that impact the heart’s rhythm, but they can measure the effects of these abnormalities on the heart.
Echocardiogram vs. electrocardiogram
An echocardiogram should not be confused with an electrocardiogram, or EKG, which is another diagnostic procedure. The electrical impulses or waves that flow through cardiac muscle tissue are measured by an EKG.
The electrical activity in the heart causes the heart muscle tissues to contract and relax, resulting in the rhythmic heartbeat that a stethoscope can detect.
Electrodes are placed on the skin of the chest, arms, or legs by a qualified technician, nurse, or doctor. These electrodes capture electrical activity and transfer it to a computer, which translates it into a graph that a doctor may see.
Are there any side effects?
An echocardiogram has a very minimal risk of problems or side effects. When the sonographer guides the tube down the throat during a transesophageal electrocardiogram, the person’s gag reflex may be triggered. After the exam, some people may experience a sore throat.
A significant consequence, such as injury to the throat, vocal cords, or esophagus, can occur very rarely as a result of the transesophageal echocardiogram.
Some people may have an adverse reaction to local anesthetics, sedatives, contrast dyes, or saline used during the exam. Only use contrast dyes if absolutely essential when pregnant.
The following are some of the potential negative effects of contrast dyes:
During a stress test, some people may experience changes in blood pressure or a reduction in oxygen delivery to the heart. In the event that a person has any issues during the assessment, a stress test will be performed in a fully equipped medical facility.
When a person is given sedatives, the stomach contents have a risk of entering the lungs. To avoid this, the patient will be asked to come to the surgery on an empty stomach.
Doctors utilize echocardiography to diagnose heart-related issues. A doctor will assess how well a person’s heart pumps blood during the test.
Doctors can also use echocardiography to check for indicators of cardiac disease such weak heart muscle, blood clots inside the heart, or malfunctioning heart valves.
An echocardiogram may be ordered by a clinician if a patient exhibits symptoms of heart disease, such as:
- heart murmurs
- irregular heartbeat
- shortness of breath
- abnormal blood pressure
- leg swelling
The test has a low risk of serious problems or side effects in general. However, some people may have discomfort, and other people may be allergic to the contrast material or anesthesia.
What to know about cerebrovascular disease
Cerebrovascular disease is a term that encompasses a variety of ailments, diseases, and disorders that affect the brain’s blood arteries and blood flow.
If the brain cells are deprived of oxygen due to a blockage, malformation, or hemorrhage, brain injury can occur.
Cerebrovascular disease can be caused by a number of causes, including atherosclerosis, in which the arteries narrow; thrombosis, or embolic arterial blood clot, in which a blood clot forms in a brain artery; and cerebral venous thrombosis, in which a blood clot forms in a brain vein.
Cerebrovascular disease is the sixth leading cause of mortality in the United States. In 2017, it resulted in 44.9 deaths per 100,000 people, totaling 146,383 deaths.
People can, however, take actions to lower their risk of acquiring cerebrovascular disease. We’ll go through the symptoms, kinds, and treatments for these major health issues, as well as how to avoid them, in this post.
Cerebrovascular disease can be caused by a number of factors.
If a blood artery in the brain is damaged, it will be unable to provide enough or any blood to the brain region it serves. The absence of blood obstructs the supply of necessary oxygen to brain cells, which causes them to die.
Damage to the brain is irreversible. Emergency assistance is critical in reducing the likelihood of long-term brain damage and increasing a person’s chances of life.
Cerebrovascular disease is mostly caused by atherosclerosis. This happens when high cholesterol levels combine with inflammation in the brain’s arteries, causing cholesterol to form a thick, waxy plaque that narrows or blocks blood flow.
This plaque can restrict or totally block blood flow to the brain, resulting in a cerebrovascular event such as a stroke or transient ischemic attack (TIA).
Cerebrovascular disease includes stroke, transient ischemic attack, and subarachnoid hemorrhage.
Aneurysms and hemorrhages can be dangerous to one’s health. A blockage can occur when blood clots develop in the brain or migrate there from other parts of the body.
Cerebrovascular disease comes in a variety of forms, including:
Ischemic stroke: A blood clot or atherosclerotic plaque stops a blood artery that provides blood to the brain, resulting in a stroke. A clot, or thrombus, can develop in an already narrowed artery.
A stroke happens when the brain cells die due to a lack of blood flow.
Embolism: The most frequent form of ischemic stroke is an embolic stroke. When a clot from elsewhere in the body breaks off and goes to the brain, it blocks a smaller artery.
Arrhythmias, or irregular heart people, increase the risk of embolism.
Ischemic stroke can be caused by a rupture in the lining of the carotid artery in the neck. The rip allows blood to travel between the carotid artery’s layers, narrowing it and limiting blood flow to the brain.
Hemorrhagic stroke: When a blood artery in a portion of the brain becomes weak and breaks open, blood leaks into the brain.
The leaking blood puts pressure on the brain tissue, causing edema and brain tissue damage. Nearby parts of the brain may also lose their supply of oxygen-rich blood as a result of the hemorrhage.
Cerebral aneurysm or subarachnoid hemorrhage: These can be caused by structural issues with the brain’s blood arteries. An aneurysm is a weakened area of the artery wall that can burst and cause bleeding.
When a blood artery ruptures and bleeds between two membranes covering the brain, it is known as a subarachnoid hemorrhage.
The leakage of blood has the potential to harm brain cells.
Learn more about a thrombus, which can lead to an embolism, in this article.
The symptoms of cerebrovascular disease vary depending on where the blockage is located and how it affects brain tissue.
Different events may have different consequences, however the following are frequent symptoms:
- losing vision on one side
- loss of balance
- becoming unconscious
- paralysis of one side of the body, or hemiplegia
- weakness on one side, also known as hemiparesis
- a severe and sudden headache
- difficulty communicating, including slurred speech
Response to an emergency
The American Stroke Association promotes public awareness of the F.A.S.T. acronym as a tool for detecting and responding to stroke warning signs:
- Face drooping
- Arm weakness
- Speech difficulty
- Time to call 911
If somebody displays symptoms of a cerebrovascular stroke, they should get medical help right away since it can have long-term consequences including cognitive damage and paralysis.
The most frequent form of cerebrovascular incident is a stroke.
Stroke risk rises with age, especially if a person or a close family has already experienced a cerebrovascular event. Between the ages of 55 and 85, this risk doubles every ten years.
A stroke, on the other hand, can strike at any age, including infancy.
Stroke and other kinds of cerebrovascular disease are caused by a number of factors, including:
- poor diet, and lack of exercise
- blood cholesterol levels of 240 milligrams per deciliter (mg/dl) or higher
- hypertension, which the American College of Cardiology define as blood pressure of 130/80 mm Hg or higher
A person’s chances of developing a cerebral aneurysm are increased by the same circumstances. People who have a congenital abnormality or have had head trauma, on the other hand, may be at a higher risk of developing a cerebral aneurysm.
Cerebral venous thrombosis, a blood clot affecting a vein in the brain, can also be increased by pregnancy.
Other cerebrovascular disease risk factors include:
- a vein of Galen malformation, an arterial disorder that develops in a fetus during pregnancy
- venous angiomas, which affect around 2% of the U.S. population and rarely bleed or cause symptoms
- Moyamoya disease, a progressive condition that can lead to a blockage of the cerebral arteries and their major branches
Certain medications and medical conditions can cause blood to clot more easily, increasing the risk of ischemic stroke.
In people who currently have atherosclerosis or carotid artery disease, hormone replacement treatment (HRT) may raise the risk of a heart attack.
A cerebrovascular episode need immediate medical attention. Because a person must get stroke drugs within a specified time frame from the beginning of symptoms, rapid assessment and treatment are critical.
In the event of an acute stroke, the emergency team may deliver tissue plasminogen activator (tPA), a drug that dissolves the blood clot.
A brain hemorrhage requires the attention of a neurosurgeon. They may do surgery to relieve the increased pressure caused by a bleed.
A carotid endarterectomy is a procedure that includes cutting a hole in the carotid artery and removing plaque. This re-establishes blood flow. The artery is then repaired with stitches or a graft by the surgeon.
Carotid angioplasty and stenting, which includes a surgeon putting a balloon-tipped catheter into the artery, may be necessary for some people. The balloon will subsequently be inflated to reopen the artery.
The surgeon next inserts a thin metal mesh tube, known as a stent, into the carotid artery to increase blood flow in the previously occluded artery. After the treatment, the stent keeps the artery from collapsing or shutting up.
People may endure temporary or permanent incapacity as a result of a cerebrovascular accident, which can cause lasting brain damage.
As a result, they may need a variety of supportive and rehabilitative therapies in order to maintain as much function as feasible.
These might include the following:
- Occupational therapy: This can assist a person in gaining access to resources that will enable them return to employment and daily life.
- Psychological therapy: Physical disabilities might result in unforeseen emotional demands that need extensive retraining. If a person feels overwhelmed following a cerebrovascular incident, they may benefit from seeing a psychiatrist, psychologist, or counselor.
- Physical therapy: This seeks to improve limb function, mobility, and flexibility.
- Speech therapy: After a stroke or a cerebrovascular episode, this may help people speak more effectively and restore speech.
Reducing the risk of stroke
Blood platelet inhibitors like Dipyridamole, Ticlopidine, and Clopidogrel can help prevent strokes before they happen. These can help prevent stroke in people who have had a stroke before or who have a high risk of developing one
Doctors used to suggest that people take aspirin every day to lower their risk of heart attack or stroke. Current guidelines, on the other hand, recommend that people take aspirin only if they are at high risk of a cardiovascular event and have a low risk of bleeding.
This is due to the fact that aspirin raises the risk of bleeding.
Statins are drugs that are prescribed by doctors to lower and control high cholesterol levels and reduce the risk of ischemic stroke and heart attack.
Any cerebrovascular incident is a medical emergency, and anybody who notices the symptoms should call 911 for assistance. The importance of early detection in preventing brain injury cannot be overstated.
A doctor will inquire about the patient’s medical history and look for particular neurological, motor, and sensory problems, such as:
- abnormal eye movements
- muscle weakness
- changes in vision or visual fields
- decreased sensation
- reduced or altered reflexes
A vascular abnormality, such as a blood clot or a blood artery defect, can be detected using a cerebral angiography, vertebral angiogram, or carotid angiogram. Injecting dye into the arteries reveals any clots and allows CT or MRI imaging to show their size and form.
Because it can distinguish between blood, bone, and brain tissue, a CAT scan can aid in the diagnosis and detection of hemorrhagic strokes. However, especially in the early phases of an ischemic stroke, it does not always detect damage.
Even early-stage strokes can be detected with an MRI scan.
A cardiac arrhythmia, which is a risk factor for embolic strokes, can be detected by an electrocardiogram (EKG or ECG).
The following are some methods for lowering the risk of cerebrovascular disease:
- getting at least 150 minutes of moderate to vigorous physical activity every week is recommended
- maintaining a healthy body weight by consuming a balanced diet that promotes vascular health, such as the DASH diet, as recommended by the National Heart, Lung, and Blood Institute
- stop smoking
- managing blood cholesterol and blood pressure with diet and medications if necessary
People who have heart arrhythmia should talk to their doctor about whether or not they should take a blood thinner to avoid strokes.
Although stroke and other cerebrovascular events can result in death, full or partial recovery is possible with prompt medical intervention. To lower the risk of a stroke, people with cerebrovascular disease should follow healthy lifestyle advice and their doctor’s instructions.
The outlook is determined by the sort of occurrence, its intensity, and the speed with which a person receives care.
Cerebrovascular disease can kill someone or leave you disabled for a long time. Some people, on the other hand, will fully recover.
The greatest approaches to enhance a person’s outlook with cerebrovascular disease are prompt treatment and a lifestyle that decreases the chance of stroke.