Deputy Head Of Operations Clare Hiles Deputy Head Of Operations North West

Heart Disease and Stroke Coronary Vascular Disease is the overarching term that describes a family of diseases sharing a common set of risk factors. Conditions causing, or resulting from, atherosclerosis (furring or stiffening of the walls of arteries), particularly coronary heart disease and stroke. Cardiovascular Disease Outcome Strategy/Stroke Strategy

Stroke Facts Every year, approximately 152,000 people have a stroke in the United Kingdom That is more than one every five minutes In 2008, stroke was the fourth largest cause of death in the UK after heart disease, cancer and respiratory disease Stroke is the largest cause of complex disability in adults There are approximately 152,000 strokes in the UK every year.   It is estimated that 46,000 people in the UK each year have a first TIA. The incidence of stroke increases rapidly with age. Stroke incidence is generally similar for men and women, apart from strokes caused by a subarachnoid haemorrhage, where almost 80% occur in women. 10-20% of people who have had a TIA will go on to have a stroke within a month. The greatest risk is within the first 72 hours. Approximately one in six TIA’s will have a stroke within three months. The risk of a further stroke is significant and is highest in the first month. Recurrent strokes are more likely to be disabling or fatal than first-ever strokes. The cumulative risk of recurrent stroke is: First 30 days 3.1% At one year 11.1% At five years 26.4% At 10 years 39.2% Five out of every 100,000 children each year have a stroke in the UK. 50% of childhood strokes are haemorrhagic. Heart disorders cause up to 25% of ischemic strokes in children. 4

What is a stroke? Damage to part of the brain Caused by a problem with its blood supply Blood is supplied through arteries There is a ‘blockage’ or ‘burst’ Usually happens quickly and strikes suddenly- brain attack 69% of strokes are ischaemic (caused by a blockage)   19% of strokes are haemorrhagic (caused by bleeding), with 13% caused by a primary intercerebral haemorrhage, and 6% caused by subarachnoid haemorrhage. 12% of strokes are of an uncertain type.

Ischaemic stroke: 69% Can either be caused by: Cerebral Thrombosis - when a blood clot forms in a main artery leading to the brain Cerebral Embolism - when a blood clot, or sometimes a piece of fatty debris from another part of the body is carried in the bloodstream to the brain An ischaemic stroke can either be caused by: a cerebral thrombosis – when a blood clot forms in a main artery leading to the brain, or • a cerebral embolism – when a blood clot, or sometimes a piece of fatty debris from another part of the body is carried in the bloodstream to the brain. Atherosclerosis When we are young our arteries are wide and flexible, but as we get older the artery walls become thicker and less flexible. A condition called atherosclerosis can then develop. This is a term used to describe the hardening and thickening of the large arteries in the body. A harmful build-up of fatty deposits, or patches called ‘atheroma’, develop on the inside walls of the arteries. They can become more and more ‘furred up’ over time, as the patches make them narrower and reduce the blood flow through them. This makes a blockage more likely to occur. As well as making arteries narrower, atherosclerosis can make the inner Ischaemic stroke surface of the artery walls fragile and likely to break up. This exposes the lining of the artery and causes blood to clot over it. This clot can then cause a blockage in the artery at this point, or the clot could break off and travel in the bloodstream causing a blockage somewhere else. About 50 per cent of ischaemic strokes are caused by atherosclerosis in the large arteries in the body. This is more likely to be the cause of stroke in older people. Embolism from the heart A blood clot forming in the heart and travelling to the brain causes about 20 per cent of ischaemic strokes. The heart condition atrial fibrillation (AF) is the most common cause of this. If you have AF your heart beats very fast and irregularly, making blood clots much more likely to form. Strokes caused in this way are usually more severe as the blood clots that travel from the heart are often quite big, and can therefore cause more damage. Small vessel disease This is a condition where the tiny blood vessels deep in the brain can become completely blocked and cause a stroke. About 25 per cent of ischaemic strokes are caused in this way and they are often called lacunar strokes. Some people experience silent lacunar strokes, which have no symptoms and may only be discovered when having a brain scan for another reason. Other causes About five per cent of ischaemic strokes are caused by other rarer causes such as: Arterial dissection – sometimes a tear can develop in an artery. This usually happens in an artery in the neck, and is due to an injury such as whiplash, but it can happen for no apparent reason. When an artery tears, blood can get between the layers of artery walls which can lead to a clot forming, causing a blockage. This is more common in younger people. Patent Foramen Ovale (PFO) – a condition affecting the heart. Foramen ovale is the name of the hole between the right and left side of your heart. This hole should close after birth, but in as many as one in four people it remains open. It usually causes no problems but it is possible for a blood clot to travel from the right to the left side of the heart and then enter the circulation system, potentially causing a stroke. This is also more likely to occur in younger adults. 6

Haemorrhagic stroke: 19% Arteries burst sending blood rushing out of the artery Blood leaks out into the brain at high pressure, the damage caused is often greater The damaged cells can die: an area of dead cells is known as an infarct Blood from the heart is pumped along a network of blood vessels (called arteries) towards the brain. This blood contains oxygen and nutrients that the brain needs to stay alive. The arteries that travel along the neck to the brain are large and as they enter the brain they branch off into smaller and smaller arteries. These carry blood to the deepest parts of the brain. Sometimes these arteries burst sending blood rushing out of the artery, instead of into the brain cells. This is called a haemorrhagic stroke. Intracerebral haemorrhage When an artery inside the brain bursts it is called an intracerebral haemorrhage. Only 13 per cent of all strokes are intracerebral haemorrhages, however, because the blood leaks out into the brain at high pressure, the damage caused is often greater. If the blood that escapes has nowhere to go, it collects at the point of the leakage and as it grows it begins to congeal (clot) forming a mass that appears jelly-like, called a haematoma. The escaping blood causes damage to the brain cells that it contacts because of the pressure and because it blocks the oxygen and nutrients from reaching the cells. The damaged cells can die and an area of dead cells is known as an infarct. The blood usually clots within a few minutes, and over a period of months it is broken down and reduced in size as the white blood cells in the body absorb the clot. Both the size of the brain injury and the area of the brain affected determine how serious a stroke is. Aneurysm An aneurysm is a weakened spot on an artery that has ballooned out. The artery walls are usually thick and strong but the walls of an aneurysm are thin and weak because they have been stretched, and can burst easily. The bulging appearance differs in cause and shape and there are several types; the most common type in the brain being a berry aneurysm (so-called as it looks like a berry). Most aneurysms are present from birth. High blood pressure is the primary cause of a ruptured aneurysm. The pressure creates a bulge in an artery that eventually bursts. Sometimes people are born with other abnormal arteries. There are several different types, some of which can lead to haemorrhagic strokes if the thin vessel walls break. These are termed arteriovenous malformation (AVM), cavernous malformation and venous malformation. AVMs are rare and affect only 1 per cent of the population. The risk of a bleed from an AVM is about 1 in 50 each year. Cavernous malformations are less common. Rarer still is a bleed from a venous malformation. It is not known why some people are born with these but advances in imaging techniques are enabling us to learn more about them. A haemorrhage can also happen because of poorly controlled medication taken to prevent the blood from clotting, for example, to treat an existing medical condition. This is to reduce the risk of a blood clot forming and travelling to the brain causing an ischaemic stroke, or to the heart causing a heart attack. These medicines are called anti-coagulants and should be carefully monitored. Symptoms Symptoms can include a severe headache, altered consciousness, vomiting and a stiff neck as well as weakness, difficulty speaking and being understood, dizziness, vertigo, blurred vision, numbness and/or pins and needles See Fact sheet 25 7

Transient Ischaemic Attack Occurs when the brain’s blood supply is briefly interrupted Classification: effects last no longer than 24hours from onset or the symptoms start to resolve within 1–20 minutes Very rarely, symptoms of a TIA are due to bleeding (haemorrhage) in the brain The FAST test helps people to quickly recognise the key symptoms of a TIA or stroke Transient ischaemic attack (TIA) is often called a mini-stroke or mild stroke. The symptoms are very similar to those of a full-blown stroke, but they only last for a short time, anything from few minutes up to 24 hours. If you have had a TIA you will recover completely within about a day. If your symptoms have lasted longer than 24 hours you have not had a TIA, you may have had a stroke. A TIA is a sign that part of the brain is not getting enough blood and that there is a risk of a more serious stroke in the future. Each year approximately 65,000 people have a first TIA. There is no way of telling whether a TIA or stroke is occurring during the first few hours, so a TIA should be treated as an emergency and you should seek urgent medical attention for assessment. The symptoms The FAST test (Face# Arms Speech Time) helps people to quickly recognise the key symptoms of a TIA or stroke If the person fails any one of these tests, they should seek urgent medical attention. Other symptoms of a TIA or stroke may include: . weakness, numbness, clumsiness or pins and needles on one side of the body, for example, in an arm, leg or the face . loss of or blurred vision in one or both eyes . sudden memory loss or confusion . slurred speech or difficulty finding some words. See fact sheet 1 8

Hormonal Contraception & HRT Smoking Hypertension Risk Factors Hormonal Contraception & HRT Smoking Obesity Heart Disease Family History or Ethnicity Inactivity Binge Drinking & Substance Misuse Diabetes Previous Stroke & TIA Age 9

Reduce your risk! Quit Smoking Check your blood pressure Control your weight Exercise Regularly Watch your units Check your pulse

Stroke Association The UK’s leading stroke charity. We are changing the world for people affected by stroke. HQ in London. UK wide – England, Northern Ireland, Scotland and Wales. Directed by a council of (volunteer) Trustees. 2012 – new name and a new look.

Our vision We want a world where there are fewer strokes and all those touched by stroke get the help they need.

What do we do Provide information. Life After Stroke Services. Fund research. Campaign and lobby government. Share good practice. Raise awareness.

Prevention awareness campaigns

Act FAST Arm weakness Time to call 999 C .Facial weakness C Arm weakness Can the person raise Speech problems Can the person speak say Time to call 999 Stroke is a medical emergency.   If you see any one of these signs, seek immediate medical attention Other symptoms include: Sudden weakness or numbness on one side of the body Sudden confusion Sudden dizziness or unsteadiness Sudden visual problem Severe headache See ‘What’s the emergency’ http://www.stroke.org.uk/campaigns/current_campaigns/stroke_is_a_medical_emergency/index.html 15