At least 80 percent of coronary heart attacks start with pain in the middle of the front of one’s chest. The pain often goes up into one’s jaws and into one’s arms.
Roughly 50 percent of all deaths after a heart attack occur within the first two hours after onset of pain.
One needs to minimise all the three major risk factors for coronary disease-no smoking (including pipes and cigars), a greatly reduced fat intake, and well controlled blood pressure. Attention to these reduces coronary risk even at a very late stage, although obviously it is better to attend to them earlier.
Second, if one has angina and the attacks are becoming more frequent, then current evidence (and medical opinion) endorse the value of regular low dose aspirin, which probably reduces the risk of a fatal attack by about 20 percent.
Aspirin works by making your blood less likely to form a clot inside a narrowed coronary artery, the final step which precipitates a coronary heart attack. A much more drastic, although more effective step, is to take a more powerful anti-coagulant drug such as warfarin. Since blood coagulability varies from day to day and week to week, anti-coagulant treatment is safe only under close medical supervision, with regular blood tests to check whether the dose needs to be changed. The possible benefits from this treatment have to be balanced in each individual case against risks of bleeding from the stomach or gut, and on present evidence it is not justified except in a few people at exceptional risk, usually people with increasingly frequent and severe angina.
Third, bearing in mind the greatly increased effectiveness of ‘clot-busting’ (thrombolytic) treatment today (providing it is given early) one should take advice if one develops any pain in the front of the chest lasting 15 minutes or more.
High blood pressure over many years is one of the main causes of hardening and narrowing of the coronary arteries, the underlying reasons for angina. High blood pressure is also an immediate and reversible cause of angina, because high blood pressure increases the work the heart has to do, and therefore its demands on an inadequate blood supply. So if the blood pressure is reduced one will be less likely to have angina, even if the arteries are already hardened and narrowed. Better control of blood pressure, usually by adjusting medication, is often all many people need to abolish their angina altogether, at least for many years.
One of the commonest causes of heart failure is uncontrolled (or very poorly controlled) high blood pressure over many years.
The most common symptoms are falling blood pressure combined with increasing breathlessness and failing health in someone who has had many years of treatment for originally high blood pressure. The heart muscle becomes too week to maintain the normal blood pressure, so the blood pressure falls.
Heart failure does not mean, as some people imagine, that the heart suddenly stops beating, but that it fails to pump out of the left side of the heart the blood as fast as it comes in from the right side of the heart. This causes congestion in the lungs, increased breathlessness and / or wheezing when lying flat, sometimes a dry cough (mainly at night) and eventually swollen ankles. As the volume of blood expelled by each heart beat falls, a failing heart speeds up, with a pulse rate usually over 80 beats a minute, often much more. The heart beat may also become irregular, but there are other common and generally harmless causes of irregular heart beats, and nobody should think his heart is failing first because of irregular or ‘missed’ beats.
Treatment of heart failure has become much more effective in the past few years, as we now have ACE-inhibitor drugs available as well as the more traditional treatment with digitalis (digoxin) and diuretics (water tablets). ACE inhibitors greatly improve heart function in heart failure, whether or not this has been caused by high blood pressure, and as they can also be used to treat high blood pressure, they can be useful for people in these situations. Most people can be made very much better and survive several years more than they would without treatment.
As with coronary heart attacks, there are several different causes of stroke, all of which interact. High blood pressure is only one of these causes, but taking all strokes as a group, it is the most important cause, and also the easiest target for stroke prevention. other causes, in descending order of importance, are high blood viscosity (usually from too many red blood cells, the opposite of anaemia), diabetes, high blood cholesterol and smoking. An exceedingly larger dose of alcohol may precipitate stroke, probably by raising blood pressure too much and too fast. On the other hand, there is fairly good evidence that people who eat a lot of fresh fruit and vegetables are much less likely to get strokes.
Most people who have a major stroke could have had warning symptoms months or years earlier but these are often not recognised and never brought to medical attention.
These warning symptoms are most commonly caused by small fragments of clot detached from cholesterol plaque in the lining of neck arteries. These fragments (called micro-emboli) can travel up into the brain and the retina (the back of the eye) causing temporary symptoms which may include disturbed vision or blindness, weakness of one side of the face or one hand or one leg, loss of speech, or partial or complete loss of consciousness. These brief losses of function are called transient ischaemic attacks or TIAs. None of these symptoms lasts for more than a few seconds or perhaps minutes, as the microembolic then disintegrate, leaving no permanent damage.
Less common warning symptoms are minor strokes. They may affect areas of the brain to cause symptoms (e.g., loss of movement in the right or left limbs, through disturbance or speech impairment) that last long enough to be recognisable if and when one consults the doctor. Multiple very small strokes of this kind generally get almost completely better within 24 hours. They can cause lasting memory loss, thought disturbance and emotional distress, usually with big ups and down in ability, and quite different from the steadily advancing impairment of Alzheimer’s disease). The disturbance and distress may be obvious to members of the same household or close friends, but not at all apparent to people (such as doctors and nurses) who don’t live with the person affected.
To prevent strokes, it is important to have one’s blood pressure checked and get it well controlled if it turns out to be high. The aim should be to have a diastolic pressure below 90 mm Hg if it is possible. Smoking, if it is a habit, should be stopped immediately. Even though, the reduction in risk is small it does help. One should start taking aspirin regularly, usually one tablet a day, which greatly reduces the tendency to form blood clots. This is certainly very effective in reducing transient ischaemic attacks (TIAs) and probably effective in preventing strokes. People who are at very high risk of strokes should consider full anti-coagulant treatment with warfarin or some similar drug. They usually have known carotid artery disease (i.e., affecting one or another of the arteries along the sides of the neck), and will probably be under supervision from a neurologist. What decision to take on this type of treatment depends on balancing probable gains against possible penalties, and will differ from person to person.
Surgical removal of clots and plaque from the carotid artery has been popular in North America as a way of preventing strokes but most evidence suggests that it is seldom an effective treatment.
There is no connection between a Bell’s palsy and blood pressure, and having had a Bell’s palsy does not make it more likely that one will have a stroke in the future.
A Bell’s palsy is paralysis of the seventh cranial nerve (also called the facial nerve), a nerve which starts in the brain and then branches out to reach most parts of the face. This nerve controls the muscles in the face, so if it becomes paralysed then so do the facial muscles. The paralysis usually affects either the left or the right side of the face (including the eyelids and the forehead). Occasionally it may recur later on the other side, and rarely it can affect both sides at the same time. It can occur at any age, but is most common in people who are between 20 and 50 years old. The cause of Bell’s palsy is still unknown but is probably a virus infection causing swelling of the seventh cranial nerve where it lies encased in bone close to the ear. It has nothing to do with high blood pressure.
Virtually everyone who notices a facial paralysis is afraid they are having a stroke but in fact there is absolutely no connection between a Bell’s palsy and a stroke. Strokes can certainly begin with facial weakness on one side or the other, but usually hand movements will be affected on the same side, and often the foot on that side will drag. Although a Bell’s palsy can cause some difficulty in speaking clearly if the paralysis is complete, there is no difficulty in choosing the right word or understanding the words of other people. When speech is affected by stroke there is usually at least some difficulty in remembering the right meanings of words.
Weakness of the heart muscle, calcification of the arteries (arteriosclerosis), stroke (cerebral), cardiac infarction, kidney failure-to a large extent, these dangerous complications caused by hypertension can be avoided if the disease is recognised early and properly treated.
Left untreated, high blood pressure can damage tissues and organs throughout your body. Sites in your body most affected by high blood pressure include your arteries, heart, brain, kidneys and eyes.