It is a common notion among people that 'brain attack' or 'stroke' and 'heart attack' are one and the same. There is also a profound lack of knowledge of common risk factors and symptoms of stroke. The inability of bystanders to recognise the common symptoms of stroke is a major hurdle in the appropriate management of patients with stroke as the golden hour is lost, especially in India where the pre-hospital services are not well organised. Treatment within the first 8 hours of onset of symptoms is most effective and prevents long-term morbidity and mortality.
It is estimated that one person dies of a stroke every 36 seconds in India. In a study conducted among the rural population in Maharashtra in 2012, only 51% of the 373 respondents were able to correctly identify 'stroke' as a disorder of the brain, while 19% associated it with a heart attack! Also, one-third of the respondents (34%) did not know at least one risk factor for stroke. This phenomenon is seen in both developing and developed countries, although the proportions are lower in developed countries.
What are the similarities and differences between 'stroke' and 'heart attack'?
A heart attack refers to damage to the muscle of the heart, usually from a lack of blood flow. Most of the time, a blood clot forms in one of the arteries that supply the heart muscle with blood, blocking the flow of blood. As the heart muscle starves, it begins to die, causing chest pain and other symptoms of heart attack.
A Stroke is a similar blockage in an artery in the brain or neck that supplies blood to the brain. When a clot forms in one of those arteries and stops blood flow, a section of the brain begins to die. When those cells die, the person loses whatever function those brain cells controlled. There is another category called the 'hemorrhagic stroke' in which a blood vessel bursts and bleeds in the brain.
While the common symptoms of a heart attack are chest pain, tightness and shoulder pain, the symptoms of stroke are completely different and may range from nothing to a headache, paralysis of an arm or leg, unconsciousness, coma and death. Another type of stroke is a transient ischemic attack (TIA), essentially a “mini-stroke” caused by a temporary clot. TIA symptoms are identical to those of other kinds of strokes, but because they occur quickly and usually last less than five minutes, this brain attack often goes unnoticed.While a TIA doesn’t usually cause permanent injury to the brain, it serves as a warning for patients and gives them time to seek further medical treatment in preventing ischemic or hemorrhagic strokes.
Because specific areas of the brain control certain functions, one can predict the effects of a stroke based on the location of the blockage. If the blockage occurs near the front of the brain, it can affect such things as organisation skills, memory, communication, and problem-solving. If it occurs lower down, near the brainstem, it can cause unconsciousness and an inability to breathe, swallow, or control elimination.if it occurs to one side near the temple, speech may be affected. In addition, which side (hemisphere) of the brain the stroke occurs on determines its side effects and which body functions are affected. The right side generally controls a person's emotions, creativity and abstract thinking.
If the blockage occurs anywhere on the right side of the brain, it can cause the following symptoms:
- Paralysis or weakness on the left side of the body
- Excessive talking
- An inability to perform routine tasks such as brushing the teeth, buttoning a shirt or tying shoelace
The left side controls more of speech, logic, perception and organisation. If the stroke occurs anywhere on the left side of the brain, it can cause the following symptoms:
- Paralysis or weakness on the right side of the body
- An inability to understand language
- Trouble speaking
- Memory problems
- Decreased attention span
Heart attack and Stroke have many risk factors in common. They may be modifiable or non-modifiable. Some of the modifiable risk factors include
- High Blood Pressure
- Heart Disease
- Diabetes Mellitus
- Cigarette smoking
- History of transient Ischemic Attacks (TIAs)
- High blood Cholesterol
- Lack of exercise, physical inactivity
- Excessive alcohol use
- Drug abuse
Some of the non-modifiable risk factors include-
- Age > 55 years
- Male gender
- Race (Asians and African-Americans have a greater risk than Caucasians)
- History of prior stroke
- Family history of stroke