Heart Attack and Atherosclerosis Prevention (cont.)
Heart failure
Unlike angina, a heart attack results in permanent damage of the heart
muscle. After a heart attack, the damaged portion of the heart is left with a
scar. If the amount of heart muscle damage and the area of scarring are small,
the performance of the heart as a pump will not be significantly impaired.
However, repeated heart attacks or a heart attack with extensive heart muscle
damage, can weaken the heart and cause
heart failure. People with
heart failure experience shortness of breath, tolerate exercise poorly, and lack
vigor because their weakened heart muscle cannot pump enough blood to keep their
bodies healthy and active.
What is cerebral vascular disease?
Cerebral vascular disease is caused by the
reduced supply of blood to the brain. Examples of cerebral vascular disease
include ischemic strokes, hemorrhagic strokes, and transient ischemic attacks
and are discussed below.
Ischemic stroke
An ischemic stroke is the sudden and permanent death of brain cells that
occurs when the flow of blood to a part of the brain is blocked and oxygen
cannot be delivered to the brain. Depending on the part of the brain that is
affected, strokes can result in weakness or paralysis of the arms, legs, and/or
facial muscles, loss of vision or speech, and difficulty walking.
Ischemic strokes most commonly occur when clots form in small arteries within
the brain (known as thrombosis of the artery) that have been previously narrowed
by atherosclerosis. The resulting strokes are called lacunar strokes because
they look like small lakes. In some cases, blood clots can obstruct a larger
artery going to the brain, such as the carotid artery in the neck, causing more
extensive brain damage than lacunar strokes.
A second less common type of ischemic stroke occurs when a piece of a clot
breaks loose, for example, from the carotid artery or heart, travels through the
arteries, and lodges in an artery within the brain. This type of stroke is
referred to as an embolic stroke and occurs commonly as a result of an irregular
heart rhythm such as atrial fibrillation, that causes blood clots to form within
the heart.
Hemorrhagic stroke
A hemorrhagic stroke occurs when a blood vessel in the brain ruptures, and
blood leaks into the surrounding brain tissue. A hemorrhagic stroke, like an
ischemic stroke, causes the death of tissue by depriving the brain of blood and
oxygen. The accumulation of blood from the hemorrhage also can put pressure on
adjacent parts of the brain and damage them as well.
A subarachnoid hemorrhage is a rupture of a blood vessel that is located
between the outer surface of the brain and the inside of the skull. The blood
vessel at the point of rupture often has been weakened by the development of an
aneurysm (an abnormal ballooning of the wall of the blood vessel). Subarachnoid
hemorrhages usually cause a sudden, severe headache and often are complicated by
additional neurological problems, such as paralysis, coma, and even death.
Transient ischemic attack (TIA)
A transient ischemic attack (TIA) often is
referred to as a mini-stroke. TIAs are caused by the temporary reduction in flow
of blood (ischemia) to the brain and is most often caused by a clot that
spontaneously forms in a carotid artery. Patients with TIA's often have narrowed
(or, less often, ulcerated) carotid arteries due to atherosclerosis. TIAs
typically last 2 to 30 minutes, although symptoms sometimes can last 24 hours
and can produce problems with vision, dizziness, weakness of the arms or legs,
and trouble speaking. A TIA is different from a stroke in that it does not cause
permanent death of brain tissue. Without treatment, however, patients with TIAs
are at high risk for having a stroke with permanent damage to the brain.
When does the coronary atherosclerosis process begin?
Although the coronary arteries are wide open at birth, the atherosclerosis
process begins early in life. Between the ages of 10 and 20, "fatty streaks" are
already being deposited on the inner lining of the coronary arteries. Over the
years, some of these fatty streaks grow into larger cholesterol plaques that can
protrude into the artery lumen and harden the artery walls. Many men and women
between the ages of 20 and 30 typically are unaware that their coronary arteries
are gradually accumulating cholesterol plaques. But by ages 40 to 50, many
people have developed enough atherosclerosis to put them at risk for coronary
heart disease.
Next: Have most people done enough to prevent atherosclerosis and heart attacks? »
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