By Andrea Stevens
AFRO Staff Writer
astevens@afro.com
Cardiovascular diseases encompass a range of disorders that can negatively impact the heart and blood vessels, including heart disease and stroke.
According to the Centers for Disease Control and Prevention (CDC), “in the United States in 2022, 1 in 6 deaths (17.5 percent) from cardiovascular disease was due to stroke.” The CDC also reports that “every year, more than 795,000 people in the United States have a stroke,” which is the “leading cause of serious long-term disability.”
The Mayo Clinic describes a stroke as an event that “occurs when the blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. This can lead to brain cells dying within minutes.”
After experiencing a first stroke, individuals face a significantly heightened risk of major cardiac events. Research published in the American Heart Association’s (AHA) journal, “Stroke,” found that “after experiencing a first stroke, the risk of having a major heart incident—such as a heart attack, heart failure, or cardiovascular death—within 30 days was 25 times higher in women and 23 times higher in men.”
The AHA also reports that “even one year post-stroke, both men and women continue to face twice the risk of a major cardiac event compared to individuals without a history of stroke.”
These statistics underscore the critical importance of cardiovascular health and the need for ongoing awareness and preventive measures during American Heart Month and beyond.
In the Black community, education is even more crucial.
This week, the AFRO spoke with Dr. Emma Nally, an attending physician at MedStar’s National Rehabilitation Hospital, who focuses on brain injury and stroke. Read below to learn more about what a person should do in the time immediately following a stroke.
AFRO: Can you tell me the top two things that you should be doing in the weeks and months after a cardiovascular event?
Dr. Emma Nally: I work primarily on the Brain Injury Unit and take care of people, oftentimes after they have a stroke, which is a cardiovascular event. After having a stroke, rehabilitation is very important.
We try to get physical, occupational and –if needed– speech therapy involved within 24 hours. After that first 24 hours, trying to get people moving as much as we can. Then, generally, once they’re stabilized, immediately after their stroke, they’ll come over to the Rehabilitation Hospital, where we do intensive physical, occupational speech therapy. They get at least three hours a day, and it’s important to do these interventions early, because a lot of motor recovery happens within the first three months after a stroke. We try to capitalize on that in the intensive inpatient setting, especially in more severe strokes. Immediately after the stroke, having intensive therapies is important.
Studies have shown that aerobic activity is really important. At National Rehabilitation Hospital, we have a high intensity training program where we tailor our therapy towards specific heart rate goals– making sure we’re getting that aerobic activity. Rather than doing traditional therapy methods of – for example – practicing one movement over and over again, we’re getting our patients on treadmills. They’re in harnesses to keep them to keep them up and we’re focusing on getting that heart rate up. That’s been translating into better outcomes for our patients.
AFRO: Where does the pool come in when it comes to recovery from a cardiovascular event?
EM: Aquatic therapy can be extremely beneficial, especially since it takes away the need for gravity. There are a few things that happen sort of immediately after stroke, but pool therapy would be something you do a little bit later. Oftentimes, after a stroke, it’s hard to control the bowel and bladder. And in order to do pool therapy, a lot of places do require you to have that continence.
In the inpatient rehabilitation unit we work hard towards getting continence back, that neuroplasticity to control things as simple as bowel movements. It’s very common after a stroke to lose control of the bowels, and it’s one thing we prioritize. I typically recommend pool therapy after the first six months.
AFRO: Are there specific foods that help the recovery process?
EM: We what each person’s co-morbidities are. If someone has a new history of cardiac disease, typically a low sodium diet is important. If there’s a history of diabetes, you want to make sure to monitor carbohydrate intake. For the vast majority of patients, I find that the Mediterranean diet is easy to follow because it helps keep the balance of good cholesterol and bad cholesterol.
If your cholesterol levels are balanced, that can help prevent future strokes.
I counsel my patients with the 80/20 rule. We’re human beings. We’re naturally driven to intake carbohydrates. But, if we can keep healthy choices in 80 percent of our diet, that allows for some indulgences in the other 20 percent of our diet. I find that my patients are usually able to meet that balance and have realistic goals.
AFRO: How important is time when it comes to recovery?
EM: We try to capitalize on intensive therapies and within that first three months. After that, we still see progressions up to six months and even after six months. I still see patients years after the stroke come to my clinic and they’ve made improvements.
Stroke recovery is lifelong, and people continue to have gains years after their strokes, but that immediate period is important to capitalize on.
AFRO: Mentally how would you suggest people who are recovering from a cardiovascular event move forward?
EM: I love this question because I think there is a lot of stigma around mental health. Now it’s becoming more commonplace to talk about it. Mood changes after a stroke are very common. It’s very normal to have a period of time where you have a low mood. We call it “adjustment disorder,” but it’s a sign of depression in response to your change in function. It is very common for people to take an antidepressant for a short period of time after their stroke to help support their mental health as they go through their recovery process.
AFRO: As far as stress in the recovery process–can you talk about that a little bit?
EM: Yes, I feel like everyone’s life is stressful. Having a stroke feed into the anxiety and depression. When people’s stress levels are elevated, there’s hormonal changes. Your cortisol levels are elevated, which can, in turn, cause high blood pressure. It can impair your sleep and exacerbate symptoms of anxiety, which all can impair stroke recovery.
That’s why we have neuropsychologists seeing all our patients to help manage that stress. We have a case manager who’s a social worker to help patients relieve any stressors because there’s so many things to think about after a stroke. I always tell people to lean on their resources. Lean on their family members. Let people help at this time, because it’s not permanent.