A CARDIAC ETIOLOGY FOR STROKE: Our deceased friend, Walter Jose Henderson , leaves a Gift
In my previous article I mentioned the untimely and tragic death of a beloved high school classmate. He was found deceased after his house burned extensively. He had been a popular civic leader and city councilman and his death was bereaved by many.
His death being so dramatic and shocking as a result of the surmised cause of death by fire, that it made me want to investigate further to see just what actually happened to him. The death was very characteristic actually of someone who died of a natural cause while he was in the process of cooking. It seemed to be too characteristic of our “serial killer”, sudden adult or cardiac death syndrome. Indeed, he was found sitting on his couch apparently having made no attempts to escape the inferno that surrounded him. He was already deceased when the fire consumed him and the house. I had to look at his phenogram to see if he had the trait for sudden death. One look and there it was….he indeed had the arrhythmia condition that is associated with sudden death. This puzzled me and made me wonder if the stroke that he had a few years ago was somehow associated with this arrhythmia. I proceeded to search the literature online and indeed found an article linking long QT syndrome with stroke. In fact the article stated that this arrhythmia had a threefold increase in the incidence of stroke in those who had the condition.
I then decided to see if any studies linked oxygen saturation in the blood with a tendency to increased clotting in blood that could lead to stroke. Indeed, a peer reviewed journal article indicated that a decrease in oxygen saturation from respiratory or other causes caused an increased activation of the clotting factors found in human blood. Lowered oxygen is then a chemical stimulant to the cascade of events and chemicals that lead to the formation of a clot. Increased fibrinogen was a result which is the essential element in the formation of a clot in a blood vessel. It is now of concern to me if these studies were available or were old enough for the doctors who cared for him to be aware of them, when he had his stroke. When his family is more relaxed I will inquire as to what medications he had been taking for his stroke condition. Most strokes are treated with anti platelet or anti clotting drugs….blood thinners. These have no effect on cardiac arrhythmias.
My next burning curiosity was to see if those who had suffered stroke could be studied to see if they indeed also had the marker for sudden death or arrhythmia. So far, out of ten or more cases of famous persons with stroke, each and every one has the marker for either, long QT (most common) Brugada Syndrome or Wolfe Parkinson White Syndrome. This now leads me to the conclusion that stroke in the majority of cases is a cardiac problem. The arrhythmia is known to cause syncope, fainting or even seizures in the non lethal version….milder condition. So now it is apparent that stroke must now be added to the non lethal and even lethal events caused by this arrhythmia. My friend Jose, had a stroke apparently caused by an episode of the arrhythmia that did not kill him on the first episode….only to kill him years later in its final episode or event.
According to the literature, 85 per cent of all stroke cases are caused by problems with clotting in the blood vessels. Clotting problems, as we stated, can be triggered by decreased oxygen saturation of the blood. The arrhythmia causes the heart to not beat effectively causing a decrease in blood flow to certain areas, especially in the brain, since the brain receives a large proportion of cardiac output. Blood is the supplier of oxygen to all parts of the body. Hence a decrease in blood flow is a low oxygen state that triggers the clotting that is found at autopsy or on CT scans of those who have had a stroke. The implication of this is huge……that stroke can be prevented altogether with the improved diagnosis and treatment of cardiac arrhythmias.
My friend Jose was known to be a generous spirit. Indeed, he is even generous in death. Thanks so much my friend….you will be dearly missed, but I hope to make your death to be not in vain. There is a party in Heaven now…..a Kappa party.
1.Hypoxia/Hypoxemia-Induced Activation of the Procoagulant Pathways and the Pathogenesis of Ischemia-Associated Thrombosis
Shi-Fang Yan, Nigel Mackman, Walter Kisiel, David M. Stern, David J. Pinsky
Arteriosclerosis, Thrombosis, and Vascular Biology. 1999;19:2029-2035
Originally published September 1, 1999
- J Am Coll Cardiol. 2012 Apr 17;59(16):1460-7. doi: 10.1016/j.jacc.2012.01.025.
Prolongation of QTc and risk of stroke: The REGARDS (REasons for Geographic and Racial Differences in Stroke) study.