Theresa Bromley had been having headaches for a couple of days but as she suffered from migraine on and off, she didn't think anything of it. Then one morning, she got up early for work and walked into her bathroom to have a shower. A few seconds later, she fell to the ground and her three children ran to her assistance. The next thing that 40-year-old Theresa remembers is waking up in hospital.
Her sister Sinead explains what happened to her on that day last December.
"Theresa's doctor reckoned that she had a stroke overnight," she says. "She was able to get up that morning but she felt sick. It was a very severe stroke and her right-hand side was paralysed and her speech was affected.
"The kids found Theresa in the bathroom and they rang their dad Brian, who called an ambulance."
Theresa had developed a stroke as a result of atrial fibrillation, an irregular heart rhythm condition that is estimated to affect around 40,000 Irish people although the figure is thought to be even higher.
Dr Ronan Collins, consultant physician in geriatric and stroke medicine at Tallaght Hospital, explains it in layman's terms.
Pump
"To try and give you a picture of what atrial fibrillation is, it's useful to think of your heart as a pump," he says. "This pump has two chambers -- the upper chamber receives blood from the lungs, holds it, gives it a gentle squeeze and pushes it through a valve to a lower chamber.
"The lower chamber squeezes and pushes the blood out to the body -- the heart has two pumps working side by side.
"In the case of atrial fibrillation, the upper chamber, instead of squeezing regularly, squeezes irregularly.
"Some of the squeezes are good squeezes, some of them are weak uncoordinated squeezes and part of the upper chamber wall may not move well at all.
"When blood isn't agitated or pumped around effectively, it stagnates and clots. The basis of atrial fibrillation is that you have part of the upper chamber wall not moving well and in that small area, a blood clot can form. If it falls into the lower chamber of the heart, it will be pumped out to the circulation."
This is the danger zone -- the first major exit off the aorta is to the brain and that means the clot can travel to the brain and cause a stroke.
While younger and middle-aged people can develop atrial fibrillation (AF), it's much more common in older people.
"The incidence of irregular heart rhythm -- either persistently or occurring intermittently -- in people over the age of 65 is probably in the order of five per cent of the population and that is a serious health issue," says Dr Collins.
"In most cases, people will not realise that their heart is doing this because it rarely causes any symptoms that you feel. It won't make you feel breathless, it won't cause chest pain and you won't get a stroke immediately.
"In some cases, the irregular heart rhythm will become quite fast but that is the exception instead of the rule, especially with AF in older people.
"The majority of people who have AF have no idea they have it and indeed sadly the first indication may be when a stroke has already occurred."
In Theresa's case, she had suspected that she may have a heart condition because of her family history, but numerous ECG tests had come back clear.
Theresa's mother had suffered from a racing heart rhythm.
"Mum suffered for four or five years where her heart would race very badly and she'd have to go to the hospital and get the paddles done to get her into a regular rhythm again," says Theresa's sister Sinead.
"Doctors thought that it could have been a tumour on the heart that was messing with the electrics. Though it did say on her death certificate that it was atrial fibrillation -- no one really knows the answer as a post-mortem wasn't done."
Theresa's mother died suddenly 13 years ago, after hearing that her own mother had had a stroke. In light of that, Theresa has had a lucky recovery from her stroke and is doing well just eight months later.
"The first night of the stroke, Theresa was able to move her right leg and in a few days, she got the strength back in her right arm," says Sinead.
Her speech is still affected and she attends a speech therapist -- she can give short answers to questions but relies on a notepad to write down longer messages. She uses a Dictaphone machine to record her speaking exercises and listen back to how she's talking.
"The difficulty with Theresa's condition is that what she hears in her head and what comes out when she speaks are two different things," says Sinead.
Theresa, who is originally from Donegal but lives in Clondalkin, Dublin, has had to give up work for the foreseeable future. Her ex- husband has moved back into the family home to help with their three children, aged 10, 12 and 14.
Theresa is being treated with the drug warfarin, which thins her blood and reduces the risk of developing another clot.
While she doesn't suffer any side-effects, the medication does impact on the things she can eat and drink (she can't drink caffeine, alcohol and has to watch her intake of green vegetables like broccoli and spinach).
Supervised
Members of Theresa's family have been screened for AF -- two of her sisters have shown signs of it and are being medically supervised while Sinead and her brother have come back clear. Theresa's own children have been tested and show no signs of it.
It will take time for Theresa to recover and she says it did come as a huge shock to her to go through it at the relatively young age of 40.
At the other end of the age range is 85-year-old Paddy Kenna from Rathfarnham, Dublin. He experienced a stroke as a result of atrial fibrillation just two days before last Christmas.
Again, it was early morning when the stroke took effect.
"Paddy had said he didn't feel well and I asked him, 'Will I ring somebody?' He said, 'No, not in this weather' -- there was heavy snow just before Christmas," says his wife, Deborah.
"He was walking into the bathroom and I heard him fall to the ground. I knew I wouldn't be able to lift him up on my own so I rang our daughter Patricia, who has nursing experience and lives five minutes away."
Paddy had suffered a stroke on his right-hand side.
"I was lucky I wasn't on a step or anything -- I just went down without warning," he says.
An ambulance quickly came and managed to get Paddy safely out of the house despite the heavy snow and ice on the ground. He was rushed to Tallaght Hospital, a place which he and Deborah can't praise highly enough.
Paddy spent the next three months in hospital as he regained movement in his arm and leg. Having the stroke has affected his quality of life -- he can no longer drive and he uses a walker to assist him with his balance.
Thankfully his speech hasn't been affected and he's able to still crack a few jokes with visitors.
"My movement is coming back bit by bit," says Paddy. "At the start, I couldn't lift my foot and couldn't use my right arm but now I can use them and I do my exercises every morning."
With seven daughters, three sons and lots of grandchildren and great-grandchildren, life for the Kenna family was always busy and Paddy worked for many years as a railway inspector until he retired in 1990.
He had been aware of an irregular heartbeat since it was picked up during a general check-up three years previously and a pacemaker was then fitted.
Deborah says, "It's only when you see others who've had strokes that you see how bad Paddy could have been. He misses doing the garden a lot though -- he never sat down, he was always doing something."
Paddy is on a treatment for AF called rivaroxaban, which is one of a new generation of medications that's believed may one day end up replacing the well-known warfarin.
"Warfarin is an effective thinner of blood -- unfortunately though it interacts with a lot of other medications. It produces a non- predictable effect of blood thinning in one person compared to another so everybody needs a different dose and it varies from time to time within an individual so they need regular blood tests," says Dr Collins.
Risk
"There is also a three or four per cent risk of bleeding -- some of it could be trivial like a nose bleed, some could be more severe."
The newly developed range of medications, including rivaroxaban and dabigatran, are taken orally like warfarin, have a regular dose for everybody, produce a more predictable blood-thinning effect and are shown to be effective in reducing the risk of stroke in AF patients.
Dr Collins says these new medications would cut down the resources needed to administer warfarin in a hospital setting. He believes these freed-up resources could then be used for an AF screening programme (see panel).
People who have AF should be aware that it is a major cause of stroke, and that strokes triggered by AF tend to be more severe than other types.
So the bottom line is that if you have atrial fibrillation and even if you don't, watch out for the warning signs of stroke. Remember FAST -- have you got Facial weakness or Arm weakness, is your Speech affected?
If so, it's Time to get help and the sooner the better.
Originally published in
