Yet Another Cycling Forum
General Category => The Knowledge => Health & Fitness => Topic started by: fruitcake on 26 March, 2021, 12:52:57 pm
-
I've been reflecting on the news that a regular contributor to YACF has suffered a stroke and I realised I didn't actually know what stroke was. I believed it had some connection with heart attack since they are often discussed together. So I looked it up. The simple answer is that a stroke is caused by a blood clot in the brain. When you think about the importance of the brain for the normal working of the human body, you realise that a blood clot there can be catastrophic.
https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/articles/leadingcausesofdeathuk/2001to2018 (https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/articles/leadingcausesofdeathuk/2001to2018)
Stroke is among the leading causes of death in the UK, and has been for decades. It is the bottom band on that bar chart, the band labelled cerebrovascular disease.
For those who want to read up on the topic, there's info at the Stroke Association website. This includes info on how to spot the early signs of a stroke.
https://www.stroke.org.uk/ (https://www.stroke.org.uk/)
And here is the general info from NHS on stroke prevention.
https://www.nhs.uk/conditions/stroke/prevention/ (https://www.nhs.uk/conditions/stroke/prevention/)
-
You also get brain aneurysms, when a blood vessel in the brain ruptures. This is a brilliant description of what it's like to have one: https://youtu.be/UyyjU8fzEYU It's from 2008 and only in 240p but well worth the listen, if you can tolerate what my FiL would have called the airy-fairy side of it.
-
Maybe this could be shifted to Health Matters? Both posts are useful but I think it might be helpful to point out that the type of stroke caused by a clot IS owing to heart problems and that the two are inextricably connected. This thread (sadly for me!) refers:-
https://yacf.co.uk/forum/index.php?topic=113146.0 (https://yacf.co.uk/forum/index.php?topic=113146.0)
Peter
-
Heart and other problems, e.g. Covid-19 can pepper you with clots all over.
-
Sketchy memories...
Two main types of stroke
TIA - Trans Ischeamic Attack
CVA - Cardio Vascular Aneurism
Neither are particularly good, a TIA can be a predictor of an impending CVA.
Any sign of one happening (one sided paralysis) is time to get to the ED ASAP.
Aye it could possibly be bells palsy or something, but the sooner you get treated the more chance of survival you have.
Sent from my BKL-L09 using Tapatalk
-
Two main types of stroke
TIA - Trans Ischeamic Attack
CVA - Cardio Vascular Aneurism
3 main types of stroke:
Ischaemic (blockage)
Haemorrhagic (bleeding)
Transient ischaemic attack (temporary blockage)
CVA: cerebrovascular accident. A term for strokes that has fallen out of favour, as they are not accidents.
-
(https://www.stroke.org.uk/sites/default/files/symptoms_of_stroke_fast_test_infographic__0.png)
-
(https://www.stroke.org.uk/sites/default/files/symptoms_of_stroke_fast_test_infographic__0.png)
Excellent timing, I was about to post the same.
If calling an ambulance for someone else, saying "patient is fast positive" can speed things up nicely.
As a general rule, the faster an ambulance gets to you, the better. We're seeing recoveries now that would be unheard of as little as 10 years ago. Pre hospital care has come on massively.
Some strokes can be treated with clot busting drugs, for others they feed a catheter up via an artery in the leg, which basically has a cork screw on the end, and use that to pull the blockage out.
Stroke is a clot in the brain. A heart attack is a clot in the heart. Older people who live alone, and that are at risk of stroke, there are things such as panic buttons that can be literal life savers. I've no idea who you should contact about this tho if you're worried about this wrt to yourself or someone you know.
J
-
Not always clots. As Sgt P has said a couple of posts up thread, bleeds and temporary occlusions also cause Strokes.
-
Heart and other problems, e.g. Covid-19 can pepper you with clots all over.
You shouldn't really talk about hospital volunteers like that - though I've met a few tabard-fixated power-monkeys!
-
Two main types of stroke
TIA - Trans Ischeamic Attack
CVA - Cardio Vascular Aneurism
3 main types of stroke:
Ischaemic (blockage)
Haemorrhagic (bleeding)
Transient ischaemic attack (temporary blockage)
CVA: cerebrovascular accident. A term for strokes that has fallen out of favour, as they are not accidents.
Told you the memory was sketchy!
Sent from my BKL-L09 using Tapatalk
-
I have known 2 people who have survived strokes completely, both though, did have personality changes, one significantly for the better.
-
I have known 2 people who have survived strokes completely, both though, did have personality changes, one significantly for the better.
I'm intrigued, particularly about the latter part of your post.
Care to elaborate?
No pressure.
-
I have known 2 people who have survived strokes completely, both though, did have personality changes, one significantly for the better.
I'm intrigued, particularly about the latter part of your post.
Care to elaborate?
No pressure.
ex partners father, he was always very standoffish, to his children when they were young, would ignore them in the street, then in late 60's he decided t up sticks with the younger members and his wife and move to South Africa, leaving behind the older ones that didn't want to go.. Decent chap but stone cold fish. Years later he had a bad stroke, was spoon fed etc, but he recovered, then about 30 years ago ( in his early 70's) they moved back to UK, and they met up for first time in years, and he walked up to her and gave her a huge hug, then shook my hand vigorously, and he was so warm and friendly, she didn't recognise him. Complete change of personality.
-
I have known 2 people who have survived strokes completely, both though, did have personality changes, one significantly for the better.
I'm intrigued, particularly about the latter part of your post.
Care to elaborate?
No pressure.
ex partners father, he was always very standoffish, to his children when they were young, would ignore them in the street, then in late 60's he decided t up sticks with the younger members and his wife and move to South Africa, leaving behind the older ones that didn't want to go.. Decent chap but stone cold fish. Years later he had a bad stroke, was spoon fed etc, but he recovered, then about 30 years ago ( in his early 70's) they moved back to UK, and they met up for first time in years, and he walked up to her and gave her a huge hug, then shook my hand vigorously, and he was so warm and friendly, she didn't recognise him. Complete change of personality.
Ta.
-
Sketchy memories...
Two main types of stroke
TIA - Trans Ischeamic Attack
CVA - Cardio Vascular Aneurism
Neither are particularly good, a TIA can be a predictor of an impending CVA.
Any sign of one happening (one sided paralysis) is time to get to the ED ASAP.
Aye it could possibly be bells palsy or something, but the sooner you get treated the more chance of survival you have.
Sent from my BKL-L09 using Tapatalk
CVA = Cerebro Vascular Accident
Transient ischaemic attack is a short-lived episode with full recovery.
Blood vessels anywhere can suffer one of several sorts of mishap: they can
Burst/bleed
Block, due to a clot that's travelled from elsewhere, one that's developed on the spot, or from thickening of the vessel wall.
-
Our next door neighbour had a stroke, lay there for four days, which we feel bad about (she's a very independent widow so while we always chatted to her, and asked her if she needed anything when the COVID thing kicked off, she mostly kept herself to herself).
It was mostly luck she was found, we can't see into her garden or house, it was just chance that a guy on the street below was trimming some bushes at the bottom of his garden which abuts hers and he heard something, couldn't figure out what but thought it was a voice, so he called the police who had to break-in and found her on the floor of her conservatory.
She survived and is in a rehabilitation place a year later, but it's unlikely she'll ever be well enough to come back home apparently, according to the friend of hers who comes around to check the house every week.
-
My Dad died of a stroke. It's the kind of scenario you sort of "hope for" I guess, given how debilitating and scary surviving a stroke can be. He'd already said to Mum he was feeling "weird", and I presume he knew he was dying, and had just enough time/function to say to her "You'll be alright" before closing his eyes next to her in bed, whereupon he died there in her arms.
Stroke comes in all shapes and sizes, and types.
-
I do think the whole classing both a clot and a bleed as a stroke a bit confusing. Presumably you don't want to be giving clot busting drugs to someone having a bleed.
My cousin's wife had a bleed a few years ago, their youngest child was still pretty small, she would have been in her 40's I think. When he first visited her in hospital once she'd started to recover she didn't recognise him and was startled to find out she was married (she told him to GTF). Think she's mainly fine now, though does scatty stuff like leave her bank card in shops on a regular basis.
-
Cycling does not protect against strokes as well as it does against heart disease. Many strokes have no known cause but there are two big risk factors: any heart murmur (arrythmia), and high blood pressure. Don't ignore either of these, and the former often runs in families.
The haemorrhagic kind is hard to predict but you can at least reduce the risk of the clotting kind. If you're at risk, they'll put you on warfarin or similar and the prognosis is pretty good. My sister was an anti-coagulant Sister for decades.
-
A heart murmur is due to turbulence in the fluid path.
An arrhythmia is a problem with the heart rhythm.
These two are not the same.
People with rhythm trouble, like AF, can have clots develop in a stagnant corner of the heart and these can travel north to the brain, causing an 'embolic' stroke.
People with high blood pressure can burst a blood vessel in the brain, causing 'haemorrhagic' stroke.
Both rhythm trouble and high blood pressure can and should be treated to try to prevent stroke.
-
My Gran died of a stroke, aged 70 in the mid 1980's and never woke up, died two days later.
However 7 years ago a colleague had a stroke at the office. He had flown between Australia and the UK 3 times in two weeks, one morning he woke up in the hotel and his wife thought he wasn't right but he played it down and came into work anyway. Then on a conference call someone else in the meeting realised his face was drooping on one side and his speech wasn't clear, and came to me as I had a fire wardens vest (rather than being a first aider). We took all decision making away and called an ambulance for him and summoned an office first aider. The only time I have ever had to use the first aid phone number at work; "assistance to the second floor please, suspected stroke" wasn't what the first aider who answered was expecting! He was fortunate and made a full recovery, and was back in the office two weeks later. Reports from hospital had said that he was only an hour or two from a point of no return.
-
Presumably you don't want to be giving clot busting drugs to someone having a bleed..
Definitely not!
-
J, that's something that puzzled me, when I went to A & E after my TIA. They thought it probably had been a TIA, though with no imaging, and prescribed aspirin as a blood thinner until I could be seen by specialists (which took a surprisingly long time - several days, maybe even a fortnight). So, without knowing whether or not I'd bust a blood vessel, they prescribed blood-thinning, presumably based on probability. Luckily someone up there doesn't want me.
-
TIAs are frequently due to small platelet 'clots' travelling north from a rough patch in the carotid arteries or a stagnant pool in the heart. Anti-platelet medications reduce aggregation.
-
Subsequent investigation showed inefficient heart, Helly (therefore pooling or stagnation): my carotids were fine and the knife came out as easily as it went in! But they still prescribed the aspirin on probability alone, I think. Though, thinking further about it, I may be doing them a complete disservice: if I had a bust vessel, wouldn't I just keep deteriorating?
Peter
-
Aspirin and similar stop platelets aggregating but don't prevent blood clotting totally.
Although you might ooze a bit longer if you take aspirin for toothache, you are unlikely to bleed to death after a tooth extraction.
-
Unless they do it with dynamite.
-
Aspirin is seldom used for pain nowadays.
Around 50 years ago, it was in common use and there were more dental extractions.
Few folk bled to death...
-
But they still prescribed the aspirin on probability alone, I think.
There are well-established evidence-based guidelines for TIAs.
https://cks.nice.org.uk/topics/stroke-tia/management/secondary-prevention-following-stroke-tia/
https://pathways.nice.org.uk/pathways/stroke
Though, thinking further about it, I may be doing them a complete disservice: if I had a bust vessel, wouldn't I just keep deteriorating?
Indeed.
TIA - transient - symptoms usually lasting < 1 hour.
Haemorrhagic stroke (relatively rare, 15% ish of all strokes, with blockages, temporary or otherwise, being predominant): ain’t going to get better by itself.
-
A TIA is not usually considered an emergency. The usual pathway is to give aspirin (or similar) immediately, an ultrasound of the carotid arteries within a few days to look for the plaques that cause these platelet emboli and a CT scan of the brain to see if there has been any permanent damage. If surgery is indicated then it’s carried out within 6 weeks of the initial TIA. The purpose of surgery is to reduce the chances of a fully blown stroke.
A stroke is an emergency. A CT of the brain will show if the cause is a clot r a bleed and if the former then clot busting drugs are given.
-
Unless they do it with dynamite.
<makes mental note never to ask ian to recommend a dentist>
-
Cycling does not protect against strokes as well as it does against heart disease.
Going back about 15 years, my club mate Geoff had a stroke while out on the Sunday ride. For some reason, I’d left the ride early that day, can’t remember why, so I missed it happening. They were going up a hill at the time and he just keeled over. Of course, it was in an area with poor phone signal so it took ages to get the ambulance out, which can’t have helped.
You wouldn’t have had him down as a stroke risk to look at him - he was ostensibly a fit and healthy 50-something.
I’ve lost touch with most of that group now but as far as I know, he’s never ridden a bike again since then. Sad.
-
If I had to choose I'd rather have a clot than an aneurysm. A chum of mine went out one morning to push his wife's car, popped an aneurysm and died within a minute. Another was a keen climber. His left eye felt a bit funny when he was watching TV, and when he tried to tell his wife it came out very slowly. She called the emergency services and they had him on clot-busters within the hour. His speech was slurred for a few months and it was still a bit slow years later, but last I heard he was back to climbing.
-
If I had to choose I'd rather have a clot than an aneurysm. A chum of mine went out one morning to push his wife's car, popped an aneurysm and died within a minute. Another was a keen climber. His left eye felt a bit funny when he was watching TV, and when he tried to tell his wife it came out very slowly. She called the emergency services and they had him on clot-busters within the hour. His speech was slurred for a few months and it was still a bit slow years later, but last I heard he was back to climbing.
Your friend was lucky. I will take the sudden total death over the possibility of being successfully resuscitated. Stroke medicine is still in the stage of trying to keep people alive in my view. The chances of being able to climb, ride a bike or un independently after a stroke is very low. You are far more likely to end up needing permanent care.
-
Your friend was lucky. I will take the sudden total death over the possibility of being successfully resuscitated. Stroke medicine is still in the stage of trying to keep people alive in my view. The chances of being able to climb, ride a bike or un independently after a stroke is very low. You are far more likely to end up needing permanent care.
It depends a lot on how fast you're treated. We're seeing survival and recovery rates that would be un heard of 10 years ago. Emergency medicine is amazing!
J
-
I agree completely but even so I would put stroke therapy where hip replacement was 15 years ago.
-
I agree completely but even so I would put stroke therapy where hip replacement was 15 years ago.
Depends on the level of the stroke, surely? A work friend/colleague had a stroke about 3 years ago and physically appears largely fine, though has difficulty with fine motor coordination and has lost speech, so communication is more than frustrating.
My aunt's hip replacement at least 35 years ago was wholly successful, at any rate as far as I was aware at the time and subsequently.
-
I agree completely but even so I would put stroke therapy where hip replacement was 15 years ago.
Depends on the level of the stroke, surely? A work friend/colleague had a stroke about 3 years ago and physically appears largely fine, though has difficulty with fine motor coordination and has lost speech, so communication is more than frustrating.
My aunt's hip replacement at least 35 years ago was wholly successful, at any rate as far as I was aware at the time and subsequently.
I think that proves my point. After a hip replacement you can go back to running, cycling whatever, your work colleague is still suffering problems
-
The leading cause of stroke is Atrial Fibrillation (AF) much AF is asymptomatic and goes unnoticed, feeling more pulses would find more AF and avoid more strokes.
Also a bit of a pedantic point but TIA is a retrospective diagnosis, ie it means there have been neurological changes that have fully resolved within 24 hours (without another cause of the changes). If the changes are still being seen it's a CVA until proven otherwise.
-
One of Brucey's relations has just posed some details on the cycling UK forum. Apparently he's only 8 months older than me, so not quite 57. :jurek:
As a chap who lives on his own, I'm now looking at Apple Watches for their heart monitoring, fall detection & ability to call emergency services. Not a cheap option though.
-
One of Brucey's relations has just posed some details on the cycling UK forum. Apparently he's only 8 months older than me, so not quite 57. :jurek:
As a chap who lives on his own, I'm now looking at Apple Watches for their heart monitoring, fall detection & ability to call emergency services. Not a cheap option though.
FWIW, 10 days ago my "clinically certified" ECG-capable watch - the one my cardiologist had recommended, not an Apple - warned me that it had detected signs of AFIB. I printed out the trace and showed it to him: "too noisy to see anything" he said.
The trouble with such devices is that they don't monitor the heart continuously, you have to start the ECG function yourself, i.e. if you feel symptoms. Even then the signal conducted through your arms is so faint that unless you remain absolutely motionless and don't talk, other muscles firing inject a storm of interference. The recommendation with my gadget is to sit down and rest your arms on a table, which of course you have along on every ride.
IMO the best way of monitoring AFIB is probably an implantable device, which is not really available to the casual user. Short of that, getting a cardiologist to fit you with a 24-hour holter is next best (but of course you might not have AFIB during that time - it tends to come and go). AFIB watches come a poor third.
-
Old school, but checking your pulse (manually) remains a highly sensitive method for detecting AF. Specificity not good but as a method of ruling out AF, it’s pretty good.
Why bother? There is a strong association between AF and stroke. Roughly 1 in 6 strokes is due to blood clots caused by AF itself and by other factors that predispose to AF. Someone with AF is about 5 times more likely to have a stroke than someone who doesn’t. 1 in 4 people over 40 (North American numbers) will develop AF. Optimal management of AF reduces stroke risk, but you need to identify it first.
A couple of useful videos here:
https://www.heartrhythmalliance.org/aa/uk/know-your-pulse
There is an app mentioned in one of those videos called Fibricheck which uses the phone camera as a way to measure pulse rate and rhythm. I have tried it just now, on behalf of you all :P It’s all right I suppose. You need to sign up and get an account. I suspect at some point, money will be asked for. When you use it, it tells you within seconds that “a medical expert has reviewed your measurement to guarantee a detailed and medical grade diagnosis”. which I find rather unlikely. Yet, when I click on the bit where it reports my pulse rate and rhythm, the small print says “this is not a diagnosis”.
There may be better apps that also use the tech that is already present in most phones. I see Dr. Fibricheck has just emailed me to say it is only free for 24 hours, which isn’t a lot of good, and they will now be unsubscribed from.
Anyway, getting back to my original point, manual pulse checks, with the Mk1 finger, are useful and it could be worth becoming familiar with the method and what the pulse normally feels like. An easy way to reassure yourself that you are not in AF.
-
Or that you are, in my case.....
-
I'm familiar with what AF feels like with mk1 finger, or ear to chest. MrsC gets them relatively frequently.
AF is really obvious. Heart beat sounds like a broken flutter.
(probably a good thing that scotland is obsessed with defrib machines and our nearest one is about 60 yards away)
-
Stupid question time: doesn't stroke* present differently in women?
If so, how does it present?
*or do I mean heart attack? But again, where do I find the info?
-
I'm familiar with what AF feels like with mk1 finger, or ear to chest. MrsC gets them relatively frequently.
AF is really obvious. Heart beat sounds like a broken flutter.
(probably a good thing that scotland is obsessed with defrib machines and our nearest one is about 60 yards away)
AF can cause palpitations but not all palpitations are AF
Is she on warfarin or similar?
-
I'm familiar with what AF feels like with mk1 finger, or ear to chest. MrsC gets them relatively frequently.
AF is really obvious. Heart beat sounds like a broken flutter.
(probably a good thing that scotland is obsessed with defrib machines and our nearest one is about 60 yards away)
AF can cause palpitations but not all palpitations are AF
Is she on warfarin or similar?
Correct correction.
She gets palpitations.
No, not on any medication, other than the shovel-full of vitamins and supplements she swallows daily.
(note, never argue with a menopausal woman).
-
Stupid question time: doesn't stroke* present differently in women?
If so, how does it present?
*or do I mean heart attack? But again, where do I find the info?
Don't know about stroke, but AIUI it's a common misconception that women are at lower risk of heart attack than men, and symptoms are often ignored or misdiagnosed.
More here:
https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/women/misdiagnosis-of-heart-attacks-in-women
-
I was diagnosed with AF in July last year. It was quite weird. My normal resting pulse rate was about 50 bpm. Those 50 "strong" beats were still present, but there was an odd fluttering going on between times. I went to A & E and the machine said my pulse rate was 150ish per minute. They brought it down with some sort of intravenous drug. Since then I've been on bisoprolol (beta blocker) and edoxaban (blood thinner). Those two are for life, apparently. I've cut down massively on booze and lost weight, and I've averaged about 9300 paces or equivalent per day so far this year. I haven't noticed the AF return.
Raphael Behr wrote a good description of his heart attack from just over a year ago. https://www.theguardian.com/commentisfree/2020/jan/29/heart-attack-brexit-politics
-
I've cut down massively on booze and lost weight, and I've averaged about 9300 paces or equivalent per day so far this year. I haven't noticed the AF return.
That’s good going :thumbsup:
-
I agree completely but even so I would put stroke therapy where hip replacement was 15 years ago.
Depends on the level of the stroke, surely? A work friend/colleague had a stroke about 3 years ago and physically appears largely fine, though has difficulty with fine motor coordination and has lost speech, so communication is more than frustrating.
My aunt's hip replacement at least 35 years ago was wholly successful, at any rate as far as I was aware at the time and subsequently.
I think that proves my point. After a hip replacement you can go back to running, cycling whatever, your work colleague is still suffering problems