Pattern of Risk Factors of Cardioembolic Stroke in Dhamar Governorate Yemen ()
1. Introduction
Stroke is defined by WHO as rapidly developing clinical signs of focal/globaldisturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than of vascular origin [1] . It is typically characterized as a neurological deficit attributed to an acute focal injury of the central nervous system by a vascular cause, including cerebral infarction, intra-cerebral hemorrhage, and subarachnoid hemorrhage (SAH). Stroke is becoming common disease worldwide, and has an increased rate of recurrence yearly after a transient ischemic attack (TIA) or stroke [2] . Stoke is classified on basis of its cause as Hemorrhagic Stroke (13%), ischemic Stroke, (87%) [3] [4] . The Ischemic stroke is produced by occlusion of a cerebral artery Cryptogenic (31%), cardio-embolic (29%), Lacunar (21%), Large Vessel Atherosclerotic (15%) and Other (5%) [5] . cardioembolic stroke has significance for 2 reasons. First, cardiac embolism causes more severe strokes than other ischemic stroke subtypes [6] . Cardio-embolic Stroke is caused primarily by cardiac diseases that predisposes the patient to form a thrombus within the heart wall or left heart valves which may then detach and embolism into the arterial circulation and lodge within a cerebral artery and occlude blood flow and the most commonly caused by atrial fibrillation.
Cardiac embolism accounts for an increasing proportion of ischemic strokes, and might multiply several-fold over the next decades [2] [7] . Cardioembolism is responsible for nearly 30% of the origins of ischemic stroke, cardiac embolism causes more severe strokes than other ischemic stroke subtypes [8] [9] [10] Currently, new therapies are being introduced and these are specific to certain cardio-embolic diseases. Nowadays, new oral anticoagulants (NOAC) have been used to better control nonvalvular atrial fibrillation [11] .
Treatment options are limited to thrombolysis, but only few patients receive this treatment owing to restrictions in application time and indication [12] .
2. Clinical Methods
The current study was done on 77 hospitalized patients who admitted as case of cerebrovascular disease in Al-Wahda teaching hospital and other hospitals in Thamar governorate, Yemen. The presence of a typical clinical presentation and neuroimaging profile, positive evidence of a high-risk cardiac source, and the exclusion of a large artery plaque suffice to establish a diagnosis of cardioembolic stroke. The data will be collected over a period of six months, which will include the information obtained by study procedures. The data will be analyzed by SPSS (version 2020) using percentage, mean and SD, P value correlation.
3. Results
The current study was done on 77 hospitalized patients who admitted as case of cerebrovascular disease. As shown in Table 1, 44 (57.1%) were male patients, and 33 (42.9%) were female. As for age, 38 (49.4%) of all patients were the ages of more than 75 years old, which was the major group, 33 (42.9%) were between 45 - 74 years old, whereas 6 (7.8%) were between 15 - 44 years old. The results indicated that 45 (58.4%) of all patients chewed khat, which was the largest
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Table 1. Socio-demographic character Response, DM and special habits (n = 77).
percentage, followed by 35 (45.5%) as smokers and 11 (14.3%) as shamma users (Figure 1). For patients with diabetes mellitus, 30 (39%) of all cases, more duration between 5 - 10 years 14 (46.7%), 20 (66.7%) was under control. Table 2 and Table 3 shows the results about drug use, family history and the investigation.
4. Discussion
Stroke and ischemic heart disease are among the leading causes of death and disability worldwide. Even more worrisome is that in the recent year’s stroke rates are gradually increasing in certain developing nations. There is a suggested escalation in the prevalence and incidence of stroke in India over the last 3 decades. While the frequency of the specific causes of ischemic stroke may differ around the world, [12] [13] the purpose of this review is to explore the subtype of stroke known as the cardioembolic stroke. A cardioembolic stroke is when the heart pumps unwanted materials into the brain circulation that results in the occlusion of a brain blood vessel and subsequent damage to the brain tissue. [2] The current study was done on 77 hospitalized patients who admitted as case of cerebrovascular disease in Al-Wahda teaching hospital and other hospitals in Thamar governorate, Yemen. It was observed that male patients 44 (57.1%) were more than female patients 33 (42.9%) as shown in Table 1. These results were agreeing with some previous studies, which revealed that men are at a 15% higher risk of having a stroke and at a younger age compared to women, nevertheless, women have strokes at a later age, which makes them less likely to recover and more likely to die as a result. Where others found no significant difference between them. [14] Strokes occur in all age groups. In the present study 6 (7.8%) of all patients were between 15 - 44 years old, 33 (42.9%) were between 45 - 74 years old, whereas 38 (49.4%) were more than 75 years old, which indicates that risk of stroke increased significantly above 75 years old, according to residence 52 (67.5%) in rural and 25 (32.5%) in urban, as shown in Table 1. In the current study, we found that cardiovascular diseases from all cases 42 (54.50%) with hypertension, 3 (3.9%) had arrhythmia, 6 (7.8%) with cardiomyopathy, 9 (11.7%) with acute coronary syndrome, 1 (1.3%) with infective endocarditis. Possibly, the number of strokes caused by atrial fibrillation is larger than that described in this research, due to paroxysmal atrial fibrillation cases that may not have been diagnosed, as shown in Table 2. For patients with diabetes mellitus, 30 (39%) of all cases, more duration between 5 - 10 years 14 (46.7%), 20 (66.7%) was under control as shown in Table 1.
On current study we find that, 23 (29.9%) with past history of ischemic stroke, and 18 (23.4%) with past history of heart disease, major 11 (61.1%) was IHD. Patients with past history of drug intake 27 (35.1%) of all cases, as most of them 18 (63%) use Aspirin. Family history was 11 (14.3%) with CVA of all cases, and heart disease 4 (5.2%) as shown in Table 2. Vital sign during admission pulse rate 69 (89.6%) normal, blood pressure 41 (53.2%) high, others normal. The investigations HB, brain CT and ECG 77 (100%) done, 65 (84.4%) done RBS, 11 (14.3%) only do lipid profile, 12 (15.6%) only done Echo and 77 (100%) not
done MRI as shown in Table 3. Cardioembolic Stroke is caused primarily by cardiac diseases that predisposes the patient to form a thrombus within the heart wall or left heart valves which may then detach and embolize into the arterial circulation and lodge within a cerebral artery and occlude blood flow and the most commonly caused by atrial fibrillation. Currently, new therapies are being introduced and these are specific to certain cardioembolic diseases. Now a days, new oral anticoagulants drugs have been used to better control nonvalvular atrial fibrillation.
5. Conclusions
From the results obtained in this study, it can be inferred that:
• The risk of stroke increases with age.
• Stroke is more desirable to occur with person who has bad habits as smoking, chewing khat and chewing tobacco (shammah).
• Hypertension is one of the most important risk factors causing stroke.
• More cases from rural, may as socioeconomic or other cause.
• Difficulty with COVID-19 cases.
6. Recommendations
Primary prevention:
• Avoid shammah.
• Avoid smoking and Khat chewing.
• Control for diabetes and hypertension.
• Use Anti- hyperlipidemia drug.
Secondary prevention:
• Aspirin alone for life not enough.