‘Disease of the modern lifestyle’

As an intensive-care nurse, Mary Jarschke has treated a lot of heart-attack and stroke patients. All leave her with a sense of regret, considering how preventable many of these attacks are. What makes Jarschke particularly disappointed is when the patient is in the prime of life.

These aren’t just maladies of the elderly. Rampant obesity rates have contributed to younger-skewing rates for strokes and heart attacks alike.

Seeing a 30-something in the ICU “is not a rarity,” said Jarschke, who coordinates stroke care at Oroville Hospital. “It does happen very often to patients in their 60s, and if you’re in your 20s, that can seem like far away—but it can happen to you in your 30s, 40s, even your 20s.

“It’s such a devastating thing. Heart attacks and strokes are such life-altering events, for families as well as patients,” she said. “You can be seemingly fine one minute and then you’re not—it’s often that sudden. It can be that terrible.”

Jarschke collaborates with other North State medical professionals to improve how hospitals respond to these traumatic incidents. Just as significant, if not more so, are efforts at prevention.

“The education component of stroke and heart programs is so important,” said Jarschke. “One of the problems with attacks is they may not recognize what’s happening to them. It’s up to those of us around them to recognize symptoms and call 9-1-1.”

Heart attacks and strokes—also called brain attacks—have some symptoms and causes in common. However, there are different types of heart attacks and different types of strokes. Some stem from blocked arteries, to the heart and brain, respectively. Others come from blood clots that get “thrown” from one part of the body to a more vital area. Strokes also may be caused by traumatic injury to brain tissue.

With such a range, some patients experience pain, pressure or other symptoms before an attack, while some don’t. Further complicating recognition of an attack is how some symptoms of a heart or brain attack can mirror symptoms of other conditions.

Take diabetes, “which is very common,” Jarschke said. “Numbness and tingling that might be the symptom of a heart attack may be neuropathy from diabetes. It’s easy to dismiss it.”

That’s why doctors and nurses seek to educate the general population, not just people at risk, because a friend or relative may raise a red flag faster and make a life-saving call for emergency medical services.

Time is of the essence. A common phrase in cardiology goes, “Time is muscle”—meaning that the longer blood flow is cut off from the heart, the more heart tissue gets damaged. Heart and brain attacks are similar in this regard; Dr. Michael O’Brien, a neurologist who heads the Enloe Medical Center Stroke Program, estimates a stroke patient loses nearly 2 million neurons a minute pending treatment.

Brain attacks often follow telltale symptoms. Many people have heard the acronym FAST: Face, Arms, Speech, Time. O’Brien prefers BE FAST: Balance, Eyes, Face, Arms, Speech, Time. (See column note on page 12.)

Heart-attack symptoms aren’t as categorical—no handy acronym. Chest tightness and arm pain may signal a heart attack, but around 50 percent of cardiac patients report no such discomfort.

“Half the time there is no warning,” said Dr. Peter Wolk, chairman of Enloe’s cardiovascular department. “That’s why you can go from having no symptoms to an acute thrombotic”—and traumatic—“event in minutes or hours.”

Regular checkups and tests can help doctors mitigate risk factors. Most people know what endangers them: poor diet, lack of exercise, smoking. Wolk and O’Brien also point to drug use, which brings us back to the risk for young people.

Since the 1990s, O’Brien said, he’s seen more strokes from people using methamphetamine. “There’s no safe dose of that drug,” he said. “It’s not something you want to play around with.”

His cardiologist colleague feels the same way. Poor choices can lead to critical conditions.

“This is a disease of the modern lifestyle,” Wolk said. “We didn’t see this disease when everyone was a hunter-gatherer. I’m convinced this disease can be totally controlled and eliminated if people change their lifestyle and habits.

“Weight loss is the best drug that I have; it’s just the hardest pill to swallow,” he added. “Start early. This disease starts in the 20s and takes a lifetime to present.”