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Heart-related strokes trigger 'double-jeopardy' race against time

HOUSTON -- (May 1, 2007) -- When a stroke stems from disorders of both the heart and mind, the window to save a victim's life closes nearly as fast as the onset of symptoms.

"In terms of damage, a stroke originating from the heart presents a double jeopardy for the patient," said Dr. Wayne Franklin, assistant professor of medicine-cardiology at Baylor College of Medicine in Houston. "The treatment and recovery effort are magnified."

Roughly 20 percent of all instances of ischemic stroke, in which blood supply to the brain is blocked, result from cardioemboli, or clots in the heart that break off and clog blood vessels in the brain.

During onset of heart-related strokes, or cardioembolic strokes, doctors are in a race against time to treat them, given that the brain cannot survive more than a few hours without treatment. The complicated nature of cardioembolic strokes, which can block blood flow to parts of the brain, makes it all the more challenging for doctors to arrive at a proper diagnosis.

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"They need a whole work-up – head CT scan, head MRI, carotid Doppler exam, EKG, echocardiogram – to determine if the cause is from a clot in the heart or from a narrowing of blood vessels," said Franklin, who is also medical director of the Texas Adult Congenital Heart Center. "Time is of the essence."

Fortunately, clot-busting medications can be administered shortly after the onset of stroke to reestablish blood flow to the brain, although room for improvement remains.

"Anti-clotting oral medications are in development that are easier to monitor and less erratic in their effect," said Franklin.

Cardioembolic stroke from clots that originate in the heart have several possible causes, the most prevalent being atrial fibrillation, a condition caused by an abnormal heart rhythm that can go undetected.

"It is quite common to have atrial fibrillation as people get older, but it can be treated with medication to prevent clot formation, and it can also be treated with drugs that control heart rhythm and rate," said Franklin.

For ischemic strokes from narrowed arteries, surgical options include carotid endarterectomy, a procedure that cleans out diseased neck blood vessels, as well as ballooning and stenting of carotid arteries, all of which go a long way toward preventing further ischemic strokes.

"Stroke is the number three killer in this country and has caused a great deal of sickness and disease," said Franklin. "But we can prevent more of it by detecting and treating it earlier."