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What tests can help predict the possibility of a heart attack?

Q: What are the tests required to investigate the probability of strokes / paralytic attacks in future? Are the symptoms of stroke same in the elders as well as those under 35 years of age? Are lipid tests and blood pressure check up necessary for those under 35 years?

A:The term stroke encompasses a wide diversity of vascular diseases of the central nervous system (cerebrovascular diseases.) Stroke is a leading cause of death and disability throughout the world. Stroke is a leading cause of long-term disability, and many persons fear stroke not because it might lead to death but that independence will be lost. Stroke changes the life of the patient and his/her family and friends. The economic consequences of stroke are huge. Besides the expenses of acute care and prevention strategies, the financial costs of rehabilitation and long-term care are considerable. In addition, stroke often means that a person no longer can work or that family members will need to change employment in order to become a caregiver. Risk factors Several factors identify persons who have the highest risk for stroke. The leading risk factor for stroke is advancing age. With lengthening of life expectancy and advancing age, the frequency of stroke will increase dramatically during the next 50 years. Still, stroke does affect persons of all ages, including children. At most age groups, stroke occurs at a higher frequency among men than among women. The exception is in young adults, in which stroke as a complication of pregnancy can lead to increased frequency in women. A history of family members with stroke or other vascular (arterial blood vessel) disease, particularly at a young age, is associated with an increased risk of stroke. Several conditions, which can be controlled or managed, are associated with an increased risk for atherosclerosis (hardening of the arteries) and stroke. Among the leading conditions are: arterial hypertension (high blood pressure), diabetes mellitus, hypercholesterolemia (high cholesterol), and smoking. In addition, other factors including inactivity and obesity can aggravate the effects of the above conditions. Other conditions that increase the risk of stroke include alcohol or drug abuse. Measures to control these conditions can lower the risk of stroke. These measures include diet, changes in lifestyle, and medications. In addition, persons with structural diseases of the heart, such as an abnormal heart valve or recent heart attack, or an irregular heartbeat (atrial fibrillation) are at high risk for blood clots to go to the brain (cerebral embolism). Less common causes of stroke include injury to an artery (dissection), inflammation of the artery, or disorders of blood clotting. Approximately 20% of strokes involve bleeding into or around the brain. In general, patients with brain haemorrhages are very seriously ill. Brain haemorrhage is second to heart attack as a medical cause of sudden death. Among the causes of brain haemorrhages are hypertension, abnormalities of blood vessels (vascular malformations or aneurysms), or blood disorders that predispose to bleeding. Bleeding also is a potential complication of medications, such as blood thinners, which are prescribed to prevent heart attack or ischaemic stroke. As a screening procedure if you are being evaluated for stroke, it is likely that your doctor will order some blood tests. Stroke cannot be diagnosed by a blood test alone. However, these tests can provide information about stroke risk factors and other medical problems, which may be important. The routinely done tests include:

  • CBC (Complete blood count)
  • PT (Prothrombin time) INR (International normalized ratio)
  • PTT (Partial thromboplastin time) and
  • Blood lipid tests like: Cholesterol, total lipids, HDL, and LDL. Elevated cholesterol (particularly "bad" cholesterol, or LDL) is a risk factor for heart disease and stroke.
  • And Homocystine levels.
The symptoms of stroke are virtually the same for young as well as the older people. Watch for these stroke symptoms for a patient having a stroke:
  • Trouble with walking
  • Trouble with speaking
  • Paralysis or numbness on one side of the body
  • Trouble with seeing
  • Headache,
  • A sudden, severe "bolt out of the blue" headache or an unusual headache, which may be accompanied by a stiff neck, facial pain, pain between your eyes, vomiting or altered consciousness, sometimes indicates you're having a stroke.
In view of the family history of stroke in your family, getting lipid tests and BP check up done regularly would be useful. In case there is propensity to develop hyperlipidaemia or hypertension, one can treat and get them into control. In addition, leading a healthy life style would go a long way in controlling the possibility of having a stroke.

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