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React to early signs of stroke - cardiologist.

Non-Communicable Diseases (NCDs) if left unattended can take life, and government has over time raised alarm concerning the NCDs.

Recently the Minister of Health and Wellness, Ms Dorcas Makgato, was quoted advising people to check for NCDs such as Sugar Diabetes, High Blood Pressure which she stated are responsible for a lot of deaths in the country.

BOPA reporter Anastacia Sibanda caught up with a cardiologist at Cardiac Clinic, Professor Kiran Bhagat to chat about stroke.

BOPA: Good afternoon Prof, I want you to educate our readers about stroke. How does stroke occur and what are the symptoms.

Prof Bhagat: Well stroke occurs when the blood supply to the brain is interrupted, damaging brain function. And it is simple yet difficult to recognise stroke. Stroke symptoms can vary in type and severity and sometimes people experience unusual symptoms. The Stroke Association recommends the FAST test to help recognise a stroke.

BOPA: Explain the test.

Prof Bhagat: There are three simple checks that can help you recognise whether someone has had a stroke or mini-stroke (transient ischaemic attack - TIA).

F - Facial weakness: Can the person smile? Has their mouth or an eye drooped?

A - Arm weakness: Can the person raise both arms?

S - Speech problems: Can the person speak clearly and understand what you say?

T - Test all three signs.

If you see any of these signs, call for medical help immediately.

Many people that we spoke to were not aware that they were having a stroke but most knew something was wrong and sought help. Younger people or people who had previously been fit and well did not recognise the symptoms or realise that they could be having a stroke.

Those whose stroke had been due to high blood pressure often commented that it was a silent condition with no warning signs. One elderly woman thought one would feel sickly with a stroke and was surprised when the paramedics said they were taking her to hospital as she felt okay.

BOPA: Sounds scary.

Prof Bhagat: Let me finish, because I want you to fully understand, that is why I am painting a picture for you. You see occasionally friends, family and even passers by spotted that the person was having a stroke. A woman had spoken to her daughter on the phone and the daughter knew something was wrong because her speech was slurred. Several people whose speech had been affected realised they were having a stroke and had written it down to alert others to get help.

Witnessing somebody having a stroke can be a very frightening experience and some people said that those around at the time understandably panicked. People were very appreciative that others had reacted quickly to get help and valued someone taking control of the situation and being calm and supportive until help arrived

BOPA: Now let's talk about the causes.

Prof Bhagat: Certain medical conditions are associated with an increased risk of stroke. These include high blood pressure, heart conditions, diabetes, raised blood cholesterol, excessive blood loss and hereditary blood clotting conditions. Other factors known to increase the likelihood of stroke are lifestyle factors such as smoking, heavy drinking, a high fat diet and having an inactive sedentary lifestyle. Stroke is also more common in people of African origin. Nine out of 10 strokes occur in people over the age of 55 and the risk of having a stroke increases with age.

Some people said how having the stroke had been a complete surprise because they had not known they had high blood pressure or Diabetes. Some people felt they had been fit and healthy before the stroke and that it had actually been caused by other conditions, for example heart conditions or a stroke which occurred during a surgical procedure, although less than one per-cent of strokes occur in this way.

BOPA: What about lifestyle, like consumption of alcohol, smoking, diet and exercise.

Prof Bhagat: You see some people had been told by their doctor that smoking had been a major cause of their stroke. Others who had given up smoking over 20 years ago or had been light smokers wondered whether this may have contributed but some thought that it probably had not. The risk of stroke declines rapidly after stopping smoking, however even passive smoking is linked to stroke.

A few people had been heavy drinkers and thought that this in combination with other factors such as smoking, poor diet and stress had contributed to them having a stroke. Drinking to excess, and particularly binge drinking, can raise blood pressure and cause stroke although research suggests that moderate drinking of around 1-2 units a day especially of red wine may reduce the risk of stroke.

High fat diet, being overweight and lack of exercise were often seen as contributing to the stroke. People realised that high fat diet can be linked to high cholesterol but some were not aware that you do not have to be overweight to have raised cholesterol. High cholesterol is sometimes hereditary.

BOPA: I once heard that high blood pressure also is a common cause of stroke. How true is that?

Prof Bhagat: That is true. High blood pressure is a common cause of stroke. Whilst some people had been aware that they had high blood pressure others had not been aware because there were often no symptoms.

BOPA: Prof some diseases are inheritedy from family members like Diabetes. What about stroke?

Prof Bhagat: Yes, some of the people that we spoke to had close relatives who had also had a stroke and wondered whether there may be a genetic link. Stroke does run in families and some specific genetic conditions can also cause stroke.

One young woman that we spoke to had a rare clotting disorder. Her father and cousin also have the condition and now take medication to prevent a stroke. She thought that smoking and taking the pill may have increased her risk of having a stroke. Another woman who had a brain hemorrhage due to arterial venous malformation, which is sometimes hereditary, worried that other people in her family may be at risk.

BOPA: Some people believe that stress also contributes to stroke, can you speak to that.

Prof Bhagat: Some people thought that having a stressful job or busy lifestyle had contributed to their stroke. Others wondered whether their stroke had been triggered by a specific stressful event.

Strokes can very occasionally be caused by once- off stressful events but the long term impact of stress on the risk of stroke is not clear and the effects may be due to the links between stress and lack of exercise and other high risk lifestyle factors.

BOPA: Ah! then stroke is caused by everything Prof.

Prof Bhagat: It is not like that. One has to take good care of his/her health, and also

heart and other vascular conditions can cause stroke because blood clots that cause a stroke sometimes occur because of heart conditions or during operations on the heart, such as bypass operation or repair of a heart valve.

A few people had been found to be suffering from a condition known as atrial fibrillation where changes in the muscles or valves of the heart cause it to beat irregularly (arrhythmia). In the general population this is quite common and is a considerable risk factor for stroke. The erratic blood flow can lead to clots which can become lodged in the blood supply to the brain.

A few people had a stroke or TIA due to a narrowing of the arteries of the neck (carotid arteries) due to atherosclerosis (furring up of the arteries).

One woman, however, thought that a vigorous neck massage precipitated clotting in her carotid artery, and another woman had been told that this type of stroke can occur because of a sudden jerk to the neck. These are relatively rare causes of stroke.

BOPA: So how does one get immediate help?

Prof Bhagat: Many called for an ambulance or called their doctor as soon as they experienced symptoms even if they did not know that it was a stroke.

Current advice is that everyone should be taken to hospital as soon as possible, regardless of severity of symptoms. If you do not pass the FAST test call for an ambulance to get immediate assessment in hospital.

BOPA: Thank you very much for your time and educating us.

Prof Bhagat: Thanks, and please take care and live a very healthy life.
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Publication:Botswana Daily News (Gaborone, Botswana)
Date:Feb 8, 2018
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