Ageing Gracefully - Raffles Medical Group

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10 Feature Raffles HealthNews 4. Brain Cerebrovascular disease, or stroke, is a very common disease in Singapore. It ranks as the fourth leading cause of death in Singapore. Almost 1,500 patients died from stroke in 2007 (Ministry Of Health Singapore). However, thanks to the excellent healthcare infrastructure in Singapore, many of our stroke patients receive prompt emergency treatment. Each year, approximately 10,000 patients are admitted with a diagnosis of stroke in Singapore. While the vast majority survive, many have residual disabilities. Stroke occurs when a portion of the brain dies because the blood vessel supplying that area: Front section of the brain showing middle cerebral artery 1. Becomes blocked (‘ischaemic stroke’) or 2. Bursts and bleeds (‘haemorrhagic stroke’) Broken blood vessel “In either case,” said Dr Alvin Seah, Neurologist, and Consultant at Raffles Internal Medicine Centre, “that area of the brain will be affected, and depending on the region affected, the patient will experience the sudden onset of severe symptoms such as numbness, weakness, difficulty in speaking, visual field loss, giddiness and so on.” To treat an ischemic stroke, blood flow must be quickly restored to the brain. Patients who are able to get medical help within three hours of the onset of a new ischaemic stroke can be treated with a ‘clot-buster’ drug (tissue plasminogen activator or TPA) which can dissolve the clot and re-open the blood vessel. If this treatment is successful, the damaged area can recover faster. Treatment for patients who pass the three hour window would focus on stabilising the patient medically, preventing complications and sending the patient for rehabilitation and physiotherapy. Patients with ischaemic stroke will usually be treated with an antiplatelet agent to prevent further stroke. Patients who are diagnosed to have a haemorrhagic stroke may need surgical intervention to remove the bleeding. The decision whether to operate depends on many factors, including the physical condition of the patient, the size and location of the bleed and the underlying causes. Whatever the initial treatment, patients will benefit from a course of rehabilitation and physiotherapy. In all patients who have suffered a stroke, and even for those patients who do not yet have a clinical stroke, treatment would focus on subsequent control of stroke risk factors and prevention of further strokes. Stroke is a common and potentially fatal illness. Controlling the risk factors is critical. In a suspected stroke, seeking treatment early may allow emergency drug therapy. In all cases, rehabilitation and physiotherapy can help the patient to either regain the previous functional status or to cope with the resulting neurological impairment. Main Risk Factors For Stroke: • • • • • Cigarette smoking Diabetes Hypertension Hyperlipidemia Older age Blood clot
Raffles HealthNews Feature 11 5. Blood Hypertension or high blood pressure is often labeled “the silent killer” as it usually has no symptoms. Yet, it can progress to develop several potentially fatal complications. It may be present and remain unnoticed for many years if you do not undergo periodic blood pressure screening. High blood pressure is when there is an increased pressure in your blood vessels and, therefore, less space for your blood to travel through. It is dangerous as it leads to complications in many organs, ranging from heart to brain to kidney. Hypertension affects 30% of those at age 50 and increases to 60-70% for those above 70 years old. Thanks to the protective nature of female hormone estrogen, women tend to have lower blood pressure before menopause. However, their blood pressure catches up with their male counterparts after menopause by the time they turn 70 years old. High blood pressure is typically treated by making changes in your lifestyle, and with drug therapy. Screening, diagnosing, treating and controlling hypertension early in its course can significantly reduce the risk of developing strokes, heart attacks or kidney failure. “Effective blood pressure control is possible,” said Dr Antono Sutandar, Cardiologist, and Consultant at Raffles Heart Centre, “However, many hypertension patients may require two or more blood pressure medications.” Prevention of hypertension only goes as far as the cause of it. While you can adjust lifestyle related causes, genetics, race, age and gender are outside the realm of change. Modifiable factors include diet, weight, exercise levels and stress management. If you have risk factors for ischemic heart disease (obstruction of blood vessels supplying the heart), blood pressure therapy would be more aggressive. For example, patients with heart failure, kidney problems and diabetes will have a lower blood pressure target. Elderly above 80 years old will have a blood pressure goal of below 150/90. HN What Is “Normal” Blood Pressure There are several categories of blood pressure, including: • • • Normal: Less than 120/80 Prehypertension: 120-139/80-89 Stage 1 high blood pressure: 140-159/90-99 Stage 2 high blood pressure: 160 and above/100 and above You should consult your doctor if your blood pressure is above your normal range. • • Stroke Blood vessel damage (arteriosclerosis) Heart attack or heart failure Kidney failure
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