By Tedler D. Depaynos, MD
The patient is an executive of a government agency who is nearing his retirement age. He is assigned in a distant province and he is driven home every weekend in his service vehicle. In this instant, he drove on his own and was about to arrive in the city when suddenly he had a headache which was increasing in severity and later dizziness or vertigo which forced him to drive himself directly to the hospital. It was good he was able to call his family who met him at the emergency room (ER).
At the ER, there was slight but apparent weakness of his left arm and drooping of his right lips. He was diagnosed to have had a sudden “stroke”. Actually, there were times when he experienced slight headaches and slight dizziness but were always transient and lasting for a few seconds only. Recently, he claimed to be getting tired easily and there were occasions that he felt heaviness and discomfort but tolerable on his left chest. It was, however, the first time for him to experience such weakness. He then concluded that probably they were warning signs!
A work up was immediately done and lucky for him his brain scan was not significant. It was observed likewise that his sudden physical deficiency disappeared after a few hours and he could move and speak normally. His “stroke” was mild and transient.
A stroke is usually due to a decreased blood supply which is carrying oxygen to a portion of the brain and this is due to narrowing or obstruction of the blood vessels (arteries) supplying it. The extent of the involved brain depends on the size of the arteries. The sudden decrease of the size of the artery may be due to spasm while obstruction may be due to a traveling blood clot or “embolus”. A rupture of the artery may also occur followed by leakage of the blood into the brain tissues. Brain tissues deprived of oxygen even for a few minutes necroses.
Arterial spasm may have varied etiologies but the most common is hypertension (HPN) or even “stress”. The patient’s blood pressure (BP) was normal and he had never a history of HPN. From time to time, he goes out with his office mates to unwind but he limited his alcoholic drinks to 1 or 2 bottles of beer only. He likewise never learned to smoke and was constantly conscious of his food intake. In short, he appeared to be maintaining a non-stressful healthy life.
On examination, however, was he was noticed to have had heart beats which were irregular. He had arrhythmia. He admitted that he had been diagnosed to have “Atrial Fibrillation” since high school and on several occasions he was given medicines for this condition to no effect. Actually, it was his wife who argued that since he never felt anything he became hard headed and discontinued the medications prescribed on his own. He was then referred to a MD Cardiologist.
The irregularity of the heart rhythm in “Atrial Fibrillation” (AF) originates from the upper or atrial chambers of the heart and this is the most common cause according to the consulted Cardiologist. There is a defect in the “electrical system” of the heart.
There are various causes of this AF so that the Cardiologist made an extensive work-up. Basically, an Electrocardiogram (ECG), Echocardiogram, chest x-ray and several blood tests were done. Diabetis Mellitus, hyperthyroidism, anemia, atherosclerosis and other diseases that could cause AF had to be ruled out or eventually treated.
While waiting for the official results, the admitting MDs in their discussion were surmising, however, that the patient’s AF was probably “congenital” or he developed this when probably he had a “heart disease” when he was still a little boy like “rheumatic heart disease”. They were also thinking that probably only a “micro” or small artery was involved and there were other arteries supplying the brain area involved so that the “stroke” was mild and transient. Since AF was the prominent initial finding, probably this was the cause of his “stroke”. AF could cause formation of blood clots usually in the atrial chambers of the heart and if this is transported to the arteries as an “embolus” it may clog the arteries and starve the organs it is supplying of blood like the brain.
The patient was eventually advised by the Cardiologist to take his medications religiously. Medicines to modulate the electrical impulses of his heart and to prevent blood clots were the main medicines prescribed. He was warned that the incidence of patients with AF having a stroke is very significant when one is reaching his senior years. A probable repeat of the incidence after a first experience is likewise very high. It could be more serious, hence, it should be prevented. **
