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We often think that only the elderly suffer from stroke. But according to reports, in India, it is estimated that nearly a fifth of first-time stroke patients admitted to hospitals are 40 years of age or younger. Stroke in young people is a major health problem for any country. According to the WHO, stroke is an event caused by the interruption of 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 brain tissue. One of the reasons for stroke in young adults could be a history of congenital heart defect. Let us first understand the link between these two conditions.
How a congenital heart defect carries the risk of stroke
All fetuses in the womb have a small opening called the 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 exposed to air. The pressure of the first breath of a newborn, closes the foramen ovale and it seals completely within a few months in almost 75 percent of cases. But in the remaining 25%, the condition is called Patent Formane Ovale (PFO). FOP passes a small amount of blood from the right side to the left side of the heart. For the majority of people, FOP does not cause any medical problems and does not require treatment. In rare cases, it can allow a blood clot to pass from the right side to the left side of the heart and travel to the brain where it can block a blood vessel and cause a stroke.
Even though the disease is common, most people with FOP never know they have it because it doesn’t cause any symptoms. It is mostly discovered when a person has symptoms such as severe migraines, a transient ischemic attack, or a stroke. The prevalence of the disease is a quarter in the general population, which increases to 40 to 50 percent in patients who have had a stroke of unknown cause, called cryptogenic stroke. In some cases, FOP combines with another condition called atrial fibrillation which increases the risk of stroke. FOP is diagnosed with an echocardiogram also known as a cardiac echo which creates an image of the heart using ultrasound.
Managing stroke with a minimally invasive procedure
Compared to pharmacological therapy, a minimally invasive procedure to close a FOP with devices such as an Occluder reduces the risk of recurrent stroke. During the procedure, a cardiologist inserts a small wire called a catheter into a vein in the thigh and guides the occluder through the blood vessels to the heart. After the device is placed on the FOP, the device’s position is verified using cardiac imaging techniques. When the cardiologist is satisfied with the positioning, the device is released to stay in the heart at all times. Over time, tissue grows on it, making the device part of the heart.
Traditionally, blood thinners 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 continued use of these drugs, even a minor cut or bruise can cause more bleeding. Thus, less invasive therapies to occlude FOP with newer devices such as Occluder have achieved excellent safety, offer patients a better quality of life and reduce the risk of recurrent stroke in patients with the disease. diseases 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 build capacity at different levels of medical care. Technological innovations are revolutionizing the healthcare industry like never before. With all the medical treatments available, living with a healthy heart should be a priority. This could be achieved through a disciplined lifestyle and a healthy routine that includes regular physical activity, a nutritious diet, as well as avoiding or restricting the consumption of tobacco and alcohol.
Dr. John Jose -Professor, Department of Cardiology, CMC Hospital Vellore and Dr. Ajit Mullasari-Director- Cardiology, The Madras Medical Mission, Hospital, Chennai.
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