Psycho-Social Factors: Stress at home and stress at work, anxiety and depressive states all have been shown to be directly and causally related.
Cardiac Causes: Strokes can occur following a heart attack, usually because of a clot formed at the site of muscle damage. In patients with enlarged ventricles also formation of blood clots can occur which can get dislodged and go to the brain artery producing an embolic stroke.
Atrial Fibrillation (AF): An important cardiac cause is a disorder of heart rhythm called atrial fibrillation. This is a chaotic beating of the upper portion of the heart called the atria.
The commonest age of acquiring this arrhythmia is after 65 years, and its incidence goes on increasing with age and after 80 years it can be present in more than 10 % of the population. These patients usually have normal heart valves and are also called “non-valvular” atrial fibrillation.
Children and young adults with narrowing of the mitral valve (Mitral Stenosis) because of rheumatic fever (fever and joint inflammation) in childhood can get rheumatic heart disease and mitral stenosis with or without a leaking valve. This disorder can be permanent or transient or paroxysmal. (Coming off and on).
The risk of occurrence of stroke in non-valvular AF can be calculated using a score based upon age, sex, history of heart failure, hypertension, diabetes, previous heart attack or disease of limb arteries and a previous stroke. Any body in AF having a score more than 1 is at a high risk for stroke. Orally administered anti coagulants are very effective in preventing a stroke in moderate or high-risk individuals.
Preventive strategies: It is recommended that every senior citizen should assess his/her stroke risk. Not to smoke, engage in physical exercise, keep BP below at least 140/90 mms Hg, optimise body weight, use statins in case of high cholesterol levels. Those with irregular pulse or palpitations get an electrocardiogram done for diagnosis of AF. If present even for short periods see a physician and take long term blood thinners (anti-coagulants) for long term under supervision.
