Arrhythmia and cerebral infarction

What is a stroke?
Stroke includes ① cerebral infarction, ② cerebral hemorrhage, ③ subarachnoid hemorrhage (Figure 1). Cerebral infarction is a disease in which the brain is necrotized by clogging of blood vessels in the brain. It is said that 10 to 20% (half within 48 hours) of stroke cerebral ischemic attack (symptoms disappear within 24 hours), which is a prelude to cerebral infarction, causes cerebral infarction in 3 months , We will investigate the cause and prevent cerebral infarction.
Cerebral haemorrhage occurs when small blood vessels in the brain are broken, but many are said to be hypertensive cerebral hemorrhage due to high blood pressure. It is possible to prevent lifestyle habits that will not result in hypertension, or to treat high blood pressure. A lot of alcohol drinking is also a cause.
Subarachnoid hemorrhage occurs in ruptured cerebral aneurysms or bleeding from cerebral vessel malformations. Subarachnoid hemorrhage is more likely to occur when smoking, drinking alcohol, or hypertension is present.

Symptoms of stroke
There are five symptoms of stroke: ① sudden half body weakness / numbness, ② sudden speech disorder / consciousness disturbance, ③ sudden vision disorder, ④ sudden dizziness · wobble · walking disturbance, ⑤ sudden severe headache. A sudden, severe headache is a symptom suspected of subarachnoid hemorrhage. If you have symptoms of stroke, please consult a special hospital immediately.
In case of suspicion of stroke, ① face (whether there is no left or right difference in smiling face), ② arm (tilting his eyes with the palm facing up and putting both arms horizontally, one side arm falls 3) Please check the three points (___ ___ ___ 0 ___ ___ 0 ___ ___ 0 ___ ___ 0 ___ ___ 0 , Arm, Speech, Time: "Visit immediately with face, arms, words"). If there is a sudden symptom, if there is one of these, the probability of stroke is said to be about 70%.

Causes of cerebral infarction (Figure 2)
Many strokes are lifestyle diseases. Figure 2 shows the progress and measures of lifestyle-related diseases. ① inappropriate lifestyle, ② border area, ③ lifestyle diseases as a risk factor, ④ lifestyle diseases as a disease (including cerebral infarction) ⑤ need for long-term care (bedridden and dementia) We will progress in the form, for example. Arrhythmia called atrial fibrillation causes cerebral infarction, in which case it causes the most severe cardiogenic cerebral embolism in cerebral infarction.
Lifestyle such as eating habits, exercise habits, resting habits (rest and sleep), taste habits (smoking, drinking) etc can be modified. There are also lifestyle diseases such as hypertension, diabetes, dyslipidemia, obesity, metabolic syndrome, etc. that can be corrected by the risk factors for stroke. As uncorrectable, there are age, sex, race, genetic predisposition and so on.

Arrhythmia and cerebral infarction - Figure 2
Inspection for cerebral infarction
Cerebral infarction includes a lacunar infarct caused by clogging of small blood vessels in the brain (cerebral hemorrhage when this blood vessel breaks), atherothrombotic cerebral infarction caused by narrowing or clogging of large blood vessels in the brain and outside the brain, atrial fibrillation Cardiogenic cerebral embolism caused by heart disease such as movement, and other cerebral infarction caused by special causes (Fig. 1). There are many heart diseases that cause cardiogenic cerebral embolism (Figure 3), but about 90% occurs due to atrial fibrillation.
For cerebral infarction, detection of lesions, evaluation of blood vessels and heart are necessary, and the following tests are performed as necessary.

Prevention of recurrence of cerebral infarction
Figure 7 shows the recurrence rate of cerebral infarction. Although 10% in 1 year and 50% in 10 years will recur, cardiogenic cerebral embolism caused by atrial fibrillation is 75.2% in 10 years, the highest rate of recurrence among cerebral infarction is.
Prevention of recurrence is started with treatment of acute stage immediately after onset (drip and drinking medicine). Figure 8 shows the strategy for preventing recurrence of cerebral infarction. Smoking cessation, salt reduction, weight loss (maintenance of proper weight by diet therapy and exercise therapy) · Modification of lifestyle such as sake, etc., drug treatment for hypertension · diabetes · dyslipidemia · atrial fibrillation · nicotine addiction etc. to hold. We will also prevent recurrence by antiplatelet drugs for lacunar infarction and atherothrombotic cerebral infarction, and anticoagulants for cardiogenic cerebral embolism. Some patients have surgical treatment and intravascular treatment.
For cardiogenic cerebral embolism caused by atrial fibrillation, an anticoagulant is needed to prevent thrombus formation in the heart (Fig. 9). Figure 10 shows an oral anticoagulant for preventing the onset and recurrence of cardiogenic cerebral embolism in atrial fibrillation. Warfarin (Warfarin Ⓡ) is prohibited from ingesting natto, chlorella, blue juice, moroheiya etc, but dabigatran etexilate (plazaxa Ⓡ), river rosaban (exazalto Ⓡ), apixaban (erythrose Ⓡ), edoxaban ) Can be ingested with new oral anticoagulants. Figure 10 shows the 10 strokes of the
Japan Stroke Association overcome the stroke.


Rehabilitation of cerebral infarction includes physical therapy, occupational therapy, speech therapy, psychotherapy. These rehabilitations are acute phase hospitals (emergency hospitals), recovery period (after 1 to 3 weeks after onset) are specialized hospitals for rehabilitation, maintenance period (after 3 to 6 months from onset) is home, facilities, sanatorial hospitals .

Prevention of cerebral infarction
In prevention of cerebral infarction, countermeasures will be different depending on progress of lifestyle diseases (Figure 2). Those with high frequency of cerebral infarction are ① hypertension, ② diabetes, ③ atrial fibrillation, ④ smoking, ⑤ dyslipidemia. On the other hand, smoking is the most effective way to prevent cerebral infarction, maintenance of ideal weight and exercise are also important (Figure 13). Please certainly combine these treatments and practice diversification management while consulting with your doctor's doctor. There is no treatment superior to prevention. Moreover , I think that you should bear in mind the 10 th stroke prevention clause created by the Japan Stroke Association (Fig. 14). Health Japan 21 recommends taking 350 g of vegetables a day. In addition, as the target value of the number of steps by everyday life, it shows 9,200 male adult males, 8,300 female females, 6,700 men of elderly men and 5,900 female females.
Please practice "1 to exercise, 2 to meal, firm smoking cessation, finally medicine".