How technology can prevent the crisis, Health News, ET HealthWorld

by Dr. John Jose & Dr. Ajit Mullasari

We often think that only older people suffer from stroke. But as per reports, In India, nearly one-fifth of patients with first-ever stroke admitted to hospitals has been estimated to be aged 40 years or less. Stroke in young poses a major health problem for any country. As per WHO, stroke as an event caused by the interruption of the blood supply to the brain, usually because a blood vessel bursts or is blocked by a clot. This cuts off the supply of oxygen and nutrients, causing damage to the brain tissue. One of the reasons of stroke in young adults could be an history of congenital heart defect. Let’s first understand the connection between these two conditions.

How congenital heart defect carries the risk of stroke
All foetuses in the womb have a small opening called a foramen ovale in the wall between the right and left atria. This hole allows blood to bypass the fetal lungs which are unable to function until they are exposed to air. The pressure from the first breath of a new-born baby, closes the foramen ovale and it seals completely within a few months in almost 75 percent of the cases. But in the rest 25 percent, the condition is called a Patent Formane Ovale (PFO). PFO lets a small amount of blood to pass from right side to the left side of the heart. For majority of people, PFO does not cause any medical problems and requires no treatment. In rare cases it may allow a blood clot to pass from right side to the left side of the heart and travel to the brain where it can block a blood vessel leading to a stroke.

Even though the condition is a common one, most people with PFO never know they have it as it causes no symptoms. It is mostly discovered when a person experiences symptom like severe migraines, transient ischemic attack, or stroke. The prevalence of the condition is one-quarter in general population which increases to 40 to 50 percent in patients who have stroke of unknown cause referred to as cryptogenic stroke. In some cases, the PFO combines with another condition called atrial fibrillation which increases the risk of stroke. PFO is diagnosed with an echocardiogram also known as cardiac echo that creates an image of the heart using ultrasound.

Managing strokes with minimally invasive procedure
When compared to pharmacological therapy, a minimally invasive procedure to close a PFO with devices such as an Occluder reduces the risk of recurrent stroke. During the procedure, a cardiologist inserts a small wire called catheter into a vein in the thigh and guides the Occluder through the blood vessels to the heart. Once the device is placed over the PFO, the position of the device is verified using cardiac imaging techniques. When the cardiologist is satisfied with the positioning, the device is released to remain in the heart permanently. Over time, tissue grows over it, making the device a part of the heart.

Traditionally, anticoagulants have been used to reduce stroke in patients, but they have been associated with a risk of bleeding. Blood thinners help prevent blood clots by thinning the blood. But with the continuous use of these drugs, even a minor cut or bruise might cause more bleeding. Thus, less invasive therapies to occlude PFOs with newer devices such as Occluder have helped achieve excellent safety, provide patients with a better quality of life, and reduce the risk of recurrent stroke in patients with conditions such as Atrial Fibrillation.

Stroke is one of the leading causes of death and disability in India. To prevent stroke, there is an urgent need to raise public awareness and capacity-building in different levels of medical care. Technological innovations are revolutionizing the healthcare industry like never before. With all the medical treatments being available, living with a healthy heart should be a priority. This could be achieved through a disciplined lifestyle and healthy routine that include regular physical activity, nutritious diet, as well as avoiding or restricting smoking and alcohol consumption.

Dr. John Jose -Professor, Department of Cardiology, CMC Hospital Vellore and Dr. Ajit Mullasari- Director- Cardiology, The Madras Medical Mission, Hospital, Chennai.

(DISCLAIMER: The views expressed are solely of the author and does not necessarily subscribe to it. shall not be responsible for any damage caused to any person/organisation directly or indirectly.)

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