TIA: the mini-stroke

Monday, October 1, 2012

Dusty Baker Rejoins Reds After Mini-Stroke” – CBSsports.com

The headlines barely touch the surface about what happened to the manager of the Cincinnati Reds in the past 10 days. Mr. Baker odyssey began with a long standing irregular heartbeat that became symptomatic and led him to be admitted to hospital. While the heart was being evaluated, he developed symptoms of a stroke with slurred speech that required emergent treatment. Now 10 days later, he is on the bench leading his team into the playoffs. Please appreciate that Mr. Baker’s medical records are not sitting on my desk as I write this but his general story is important enough for me to take license with his particular facts.

Atrial fibrillation is a common heart rhythm that affects up to 15% of the general population. The upper chambers of the heart lose the ability to squeeze in a coordinated fashion because the regular electrical signals have been disrupted and replaced with chaotic electrical activity. Each atrial muscle cell contracts individually and the top half of the heart jiggles like a bowl of Jell-O. Many patients don’t know that their heart is in A Fib but the most common symptoms tend to be palpitations, the sensation that the heart is being erratically, and shortness of breath. That lack of atrial muscle coordination decreases the heart’s efficiency by 10 -20%.

While A Fib tends not to be life threatening in itself, there are significant complications, including stroke. When the atrial jiggles, blood tends to stand still in some of the crevasses of the atrium and can potentially form small clots or thrombi. These can break loose or embolize, travel to the arteries of the brain, get stuck and prevent blood from getting through to provide brain cells with oxygen. These brain cells turn off and start to die, causing that part of the body that they control to stop working. This is a stroke. Dusty Baker was sitting in his hospital bed when his nurse noticed slurred speech and activated the hospital’s stroke team.

Brain tissue doesn’t like being without blood supply and tries to rectify the situation. Sometimes, usually within minutes but perhaps a few hours, the body can dissolve the small clot on its own and restore blood flow to the brain and resolve the stroke. This situation is called a TIA or transient ischemic attack; ischemic meaning loss of blood supply. This is a stroke that got better but the general public often refers to a TIA as a mini-stroke. The medical community refere to it as an opportunity.

Mr. Baker was sitting in a hospital bed and had immediate diagnosis and treatment. Most stokes or TIAs happen at home and the only lesson to be learned from this column is to call 911 immediately. It’s something about predicting the future. The patient and family can never know if the symptoms will get better on their own or will become permanent…and neither can the paramedic, the emergency physician nor the neurologist. The best we have is a 3 to 6 hour time frame to intervene and perhaps use clot busting drugs to return blood supply to the brain and abort a stroke.

But should a patient get better spontaneously, the opportunity exists to find out why the TIA happened and minimize the risk for the next stroke event that might not get better on its own. The common suspects need to be rounded up in a hurry; they include A Fib and carotid artery stenosis. But many times the culprit is atherosclerosis or narrowing of the small blood vessels to the brain. The treatment is less dramatic but includes using medications to lower blood pressure and cholesterol to decrease the stroke risk which can run as high as 10% within three months.

Athletes are placed on plateaus in our society and we follow their every move, on and off the field. Sometimes the things we learn shatter their images but sometime the things we learn are lifesaving. Mr. Baker will continue to give interviews about all things baseball, but it is what we learned about A Fib, TIA and mini-stroke that may make a difference to the baseball fans that hang on his every word.

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