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Is it safe to do physical activities after having heart stroke?

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Posted on Mon, 18 May 2015
Question: I have a family member that had a stroke about 6 weeks ago. The radiologist called it moderate and it lasted about 15 minutes with blurred vision the only symptom. She had no after effects. The doctor says she has no restrictions. She is on Plavix and aspirin as therapy. My question is this: We own a farm and there are a lot of jobs that require bending and leaning over a lot. She enjoys planting, pruning, weed pulling, ect, but I was concerned that the leaning over might be harmful in some way. She is very physically active and feels fine, I just wonder if there are some types of exercise that It may be better if she avoids.
doctor
Answered by Dr. Olsi Taka (1 hour later)
Brief Answer:
No added risk.

Detailed Answer:
I read your question carefully and I understand your concern.

Physical activity is very important after stroke, improves heart function and lipid control as well as improving/preserving strength and balance. Of course it is tailored according to the individual's disability left after the stroke.
In your mother's case it seems there has been no period of prolonged inactivity and she has very soon resumed normal routine without any important disability. In that case there are no particular physical activities to avoid, bending over doesn't put her in any added risk so she can continue her usual routine. There aren't any other exercise to avoid as long as she does those without any extreme exertion.

I remain at your disposal for further questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka (8 hours later)
Great! The only other thing I am confused about regarding
the stroke is that when I read on the internet it says there
is a relatively high percentage that she will have a second one.
The only risk factor she has is age. When I read that % of risk
is that with or without treatment. She is on medication so does
make the risk much lower, or is she just at high risk regardless
since she had the first stroke? Thanks and I will rate immediately!!
doctor
Answered by Dr. Olsi Taka (2 hours later)
Brief Answer:
Read below.

Detailed Answer:
I wouldn't say that age is her only risk factor at this point. A previous stroke itself qualifies as a risk factor, that's what the material you read meant for a higher percentage of having a second one. Also looking at previous exchanges you mention abnormalities in her lipid panel, that is also a risk factor for stroke.
Also as my colleague Dr Saghafi suggested one can't say to have excluded a heart related risk factor. Looking at her lesions on MRI they look to have an embolic origin, meaning they came from somewhere else, and since neck vessels were studied by ultrasound and were considered normal, one can say that there is a strong chance of that remote source being the heart. At times there are heart arrhythmias which are paroxysmal, meaning they are triggered abruptly and can end in a matter of minutes. Because they are transitory they can be missed on a routine EKG, but they carry nevertheless the potential for creating a clot in the heart which then can enter the circulation and cause a stroke elsewhere. That's why Dr Saghafi suggested 30 day EKG monitoring (through a portable device) which would increase the chances of detecting such a transient arrhythmia. It doesn't necessarily have to be 30 day monitoring, it usually is started with 24h, then one week and if those are negative 30 day devices. Nowadays there are implantable devices which can be used for 3 years, but they are still new and very expensive, not available everywhere.
So what I mean to say is that there might be other risk factors which haven't been detected.
As for what the treatment does, it is reduce that risk, generally speaking it reduces the risk by 25-30%, there is no treatment to completely prevent a second stroke I am sorry, I wish there were. There are also anticoagulant drugs like Warfarin, Dabigatran, Apixaban. If the origin was in the heart they confer a greater risk reduction and benefit than antiagregants (like aspirin and plavix), but that has to be confirmed by tests.
Feel free to ask further questions, no hurry about the rating, only when you're sure you're done with the questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka (10 hours later)
Ok, thanks! Her general practitioner told her she did all the tests
necessary for the heart with the echocardiogram and ekg. She
told her she did not think it was necessary that she see a neurologist
because he would do nothing more than she is doing with the Plavix
and aspirin. She did not want to give her a referral. However, it
sounds like she need additional heart testing. It is kind of an
awkward situation.
doctor
Answered by Dr. Olsi Taka (1 hour later)
Brief Answer:
Read below.

Detailed Answer:
I understand your situation. I don't want to push judgments. I live in a country which is not exactly well off and in the public service often EKG and echocardiogram is what the stroke patients get as well. Perhaps there are availability issues where you live as well, although would've imagined in the US (where you seem to live) at least a 24 hour Holter EKG would have been routine everywhere.
At the end of the day Plavix or Aspirine could well be what she'll need, your physician could be proven right, but to be sure and exclude the necessity of anticoagulants I think a closer look at the heart is necessary considering that MRI report. Also a statin should be added if not done already, not only for her lipid panel abnormalities but because it has been proven to have beneficial effects on blood vessel walls.
On a side note the combination of Plavix and Aspirin together for stroke prevention is not recommended for over three months as it confers no extra benefit to one of them alone, only adds the risk of hemorrhagic side effects, so after three months at most I recommend to continue only one of the two.

I hope to have been of help.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Olsi Taka

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Is it safe to do physical activities after having heart stroke?

Brief Answer: No added risk. Detailed Answer: I read your question carefully and I understand your concern. Physical activity is very important after stroke, improves heart function and lipid control as well as improving/preserving strength and balance. Of course it is tailored according to the individual's disability left after the stroke. In your mother's case it seems there has been no period of prolonged inactivity and she has very soon resumed normal routine without any important disability. In that case there are no particular physical activities to avoid, bending over doesn't put her in any added risk so she can continue her usual routine. There aren't any other exercise to avoid as long as she does those without any extreme exertion. I remain at your disposal for further questions.