ARDS and RDS: Acute and Respiratory Distress Syndromes PDF

ARDS Acute respiratory distress syndrome (ARDS) occurs when lung swelling causes fluid to build up in the tiny elastic air sacs in the lungs. These air sacs, called alveoli, have a protective membrane, but lung swelling damages that membrane. The fluid leaking into the air sacs keeps the lungs from...

ARDS Acute respiratory distress syndrome (ARDS) occurs when lung swelling causes fluid to build up in the tiny elastic air sacs in the lungs. These air sacs, called alveoli, have a protective membrane, but lung swelling damages that membrane. The fluid leaking into the air sacs keeps the lungs from filling with enough air. This means less oxygen reaches the bloodstream, so the body's organs don't get the oxygen they need to work properly. Symptoms The seriousness of ARDS symptoms can vary depending on what's causing them and whether there is underlying heart or lung disease. Symptoms include: Severe shortness of breath. Labored and rapid breathing that is not usual. Cough. Chest discomfort. Fast heart rate. Confusion and extreme tiredness. Causes of ARDS include: Sepsis. The most common cause of ARDS is sepsis, a serious and widespread infection of the bloodstream. Severe pneumonia. Severe cases of pneumonia usually affect all five lobes of the lungs. Coronavirus disease 2019 (COVID-19). People who have severe COVID-19 may get ARDS. Because COVID-19 mainly affects the respiratory system, it can cause lung injury and swelling that can lead to COVID-19-related ARDS. Head, chest or other major injury. Accidents, such as falls or car crashes, can damage the lungs or the portion of the brain that controls breathing. Breathing in harmful substances. Breathing in a lot of smoke or chemical fumes can lead to ARDS, as can breathing in vomit. Breathing in water in cases of near-drownings also can cause ARDS. Other conditions and treatments. Swelling of the pancreas (pancreatitis), massive blood transfusions and severe burns can lead to ARDS. Risk factors Most people who get ARDS already are in a hospital for another condition. Many are critically ill. People are especially at risk if they have an infection, such as sepsis or pneumonia. They're also at higher risk if they have COVID-19, especially if they also have metabolic syndrome. People who have alcohol use disorder or who use recreational drugs or smoke ― lifestyle habits that can harm the lungs ― are at higher risk of getting ARDS. Having a history of alcohol, drug or tobacco use also raises the risk of ARDS. Complications ARDS can cause other medical problems while in the hospital, including: Blood clots. Lying still in the hospital while you're on a ventilator can make it more likely that you'll get blood clots, particularly in the deep veins in your legs. If a clot forms in your leg, a portion of it can break off and travel to one or both of your lungs, where it can block blood flow. This is called a pulmonary embolism. Collapsed lung, also called pneumothorax. In most people with ARDS, a breathing machine called a ventilator brings more oxygen into the body and forces fluid out of the lungs. But the pressure and air volume of the ventilator can force gas to go through a small hole in the very outside of a lung and cause that lung to collapse. Infections. A ventilator attaches to a tube inserted in your windpipe. This makes it much easier for germs to infect and injure your lungs. Scarred and damaged lungs, known as pulmonary fibrosis. Scarring and thickening of the tissue between the air sacs in the lungs can occur within a few weeks of the start of ARDS. This makes your lungs stiffer, and it's even harder for oxygen to flow from the air sacs into your bloodstream. Stress ulcers. Extra acid that your stomach makes because of serious illness or injury can irritate the stomach lining and lead to ulcers. Thanks to better treatments, more people are surviving ARDS. But many survivors end up with potentially serious and sometimes lasting effects: Breathing problems. After having ARDS, many people get most of their lung function back within several months to several years, but others may have breathing problems for the rest of their lives. Even people who do well usually have shortness of breath and fatigue and may need extra oxygen at home for a few months. Depression. Most ARDS survivors also report going through a period of depression, which can be treated.  Problems with memory and thinking clearly. Sedatives and low levels of oxygen in the blood can lead to memory loss and learning problems after ARDS. In some people, the effects may get better over time. But in others, the damage may last for the rest of their lives. Tiredness and muscle weakness. Being in the hospital and on a ventilator can cause your muscles to weaken. You also may feel very tired after treatment. Diagnosis There's no specific test for ARDS. Healthcare professionals base the diagnosis on physical exams, chest X- rays and oxygen levels. It's also important to rule out other diseases and conditions, such as certain heart problems that can lead to similar symptoms. Imaging A chest X-ray can show which parts of your lungs, and how much of the lungs, have fluid in them and whether your heart has gotten bigger. Another test called a CT scan combines X-ray images taken from many directions and creates cross-sectional views of internal organs. CT scans can give detailed information about the structures within the heart and lungs. Lab tests A test using blood from an artery can measure your oxygen level. Other types of blood tests can check for symptoms of infection or other medical conditions. If your healthcare professional thinks that you have a lung infection, secretions from your airway may be tested to find the cause of the infection. Heart tests Because the symptoms of ARDS are like those of certain heart problems, your healthcare professional may recommend heart tests such as: Electrocardiogram. This painless test, which also is known as an ECG, tracks the electrical activity in your heart. During the test, a healthcare professional attaches several wired sensors to your body. Echocardiogram. This test uses sound waves to create pictures of the heart. It shows how blood moves through the heart chambers and heart valves, and whether there are changes in the structures of your heart. Treatment The first goal in treating ARDS is to improve the levels of oxygen in your blood. Without oxygen, your organs can't work properly. Oxygen To get more oxygen into your bloodstream, your healthcare professional likely will use:  Extra oxygen. For milder symptoms or as a short-term treatment, oxygen may be delivered through a mask that fits tightly over your nose and mouth. Mechanical ventilation. Most people with ARDS need the help of a machine to breathe. A mechanical ventilator pushes air into your lungs and forces some of the fluid out of the air sacs. Extracorporeal membrane oxygenation (ECMO) ECMO may be an option for severe ARDS when other treatment options, such as mechanical ventilation, don't work. ECMO takes over for the heart, lungs or both for a limited time while the lungs rest and heal. This treatment can help when the body can't provide the tissues with enough oxygen. The ECMO machine is an artificial heart and lung, removing blood from the body through tubes and pumping the blood through the artificial lung. This process removes carbon dioxide and adds oxygen. Then the machine pumps the blood back into the body. Because of the risks involved, it's important to discuss the pros and cons of ECMO with your healthcare team. Prone positioning For some people with ARDS, positioning on the stomach — what's known as a prone position — during mechanical ventilation may make more oxygen available to the lungs. Fluids Carefully managing the amount of IV fluids given to people with ARDS is very important. Giving too much fluid can make more fluid build up in the lungs. Giving too little fluid can strain the heart and other organs, leading to shock. Medication People with ARDS usually get medicine to: Prevent and treat infections. Ease pain and discomfort. Prevent blood clots in the legs and lungs. Reduce gastric acid reflux as much as possible. Help them feel calm or less anxious. Lung transplant When other treatments don't help, lung transplant may be an option for some carefully chosen people who have ARDS. Usually, these are people who were healthy before they developed severe ARDS. Because lung transplant is such a hard process, it should be done at a center that has highly skilled, experienced surgeons and transplant teams. Lifestyle and home remedies If you're recovering from ARDS, these suggestions can help protect your lungs: Quit smoking. If you smoke, seek help to quit. Also, stay away from secondhand smoke whenever you can. Get vaccinated. Getting the flu, also called influenza, shot every year, as well as the pneumonia vaccine as often as recommended, can lower your risk of lung infections. Attend pulmonary rehabilitation. Many medical centers now offer pulmonary rehabilitation programs that include exercise training, education and counseling to help you learn how to get back to your usual activities and get to your ideal weight. RDS Respiratory distress syndrome (RDS) occurs in babies born early (premature) whose lungs are not fully developed. The earlier the infant is born, the more likely it is for them to have RDS and need extra oxygen and help breathing. RDS is caused by the baby not having enough surfactant in the lungs. Surfactant is a liquid made in the lungs at about 26 weeks of pregnancy. As the fetus grows, the lungs make more surfactant. Surfactant coats the tiny air sacs in the lungs and to help keep them from collapsing (Picture 1). The air sacs must be open to allow oxygen to enter the blood from the lungs and carbon dioxide to be released from the blood into the lungs. While RDS is most common in babies born early, other newborns can get it. Those at greater risk are: Siblings that had RDS Twin or multiple births C-section (cesarean) delivery Mother that has diabetes Infection Baby that is sick at the time of delivery Cold, stress, or hypothermia. Baby cannot keep body temperature warm at birth. Signs and Symptoms Babies who have RDS may show these signs: Fast breathing very soon after birth Grunting “ugh” sound with each breath  Changes in color of lips, fingers and toes Widening (flaring) of the nostrils with each breath Chest retractions - skin over the breastbone and ribs pulls in during breathing Diagnosis The diagnosis is made after examining the baby and seeing the results of chest X-rays and blood tests. Treatment Oxygen - Babies with RDS need extra oxygen. It may be given several ways: Nasal cannula: A small tube with prongs is placed in the nostrils. Continuous Positive Airway Pressure (CPAP): This machine gently pushes air or oxygen into the lungs to keep the air sacs open. Ventilator (for severe RDS): This is a machine that helps the infant breathe when they cannot breathe well enough without help. A breathing tube is put down the infant’s windpipe. This is called intubation (in-too-BAY-shun). The infant is then placed on the ventilator to help them breathe. Surfactant - Surfactant can be given into the baby’s lungs to replace what they do not have. This is given directly down the breathing tube that was placed in the windpipe. Intravenous (IV) catheter treatments - A very small tube called a catheter, is placed into one or two of the blood vessels in the umbilical cord. This is how the infant gets IV fluids, nutrition and medicines. It is also used to take blood samples. Medicines - Sometimes antibiotics are given if an infection is suspected. Calming medicines may be given to help ease pain during treatment. Warning The medical device tubing can get wrapped around a child’s neck. This can lead to choking (strangulation) or death. DO NOT leave the medical device tubing where infants or children can get tangled up in it. Talk to your child's health care provider: o If your child has been tangled in their tubing before. o To learn steps you can take to help make sure the tubing does not get wrapped around your child’s neck, such as keeping the tubing away from the child as much as possible. o Any other concerns you may have about the risk of strangulation from medical device tubing. If your child is injured by the medical device tubing, please report the event to the FDA. Your report can provide information that helps improve patient safety. The website to make a report What to Expect The road to recovery is different for each infant. Often RDS gets worse before it gets better. Some babies need more oxygen than others. Some may require a treatment of surfactant. As the baby is able to breathe better, they may need less oxygen and other help to breathe. How to Know if Your Infant is Getting Better Here are some signs that your baby is getting better. They will: Breathe easier and more slowly and look more comfortable breathing. Need less oxygen. Have the settings lowered or decreased, if using a CPAP or on a ventilator. After a while, help from the machines will no longer be needed. Heart attack A heart attack occurs when the flow of blood to the heart is severely reduced or blocked. The blockage is usually due to a buildup of fat, cholesterol and other substances in the heart (coronary) arteries. The fatty, cholesterol-containing deposits are called plaques. The process of plaque buildup is called atherosclerosis. Sometimes, a plaque can rupture and form a clot that blocks blood flow. A lack of blood flow can damage or destroy part of the heart muscle. Heart attack A heart attack occurs when an artery that sends blood and oxygen to the heart is blocked. Fatty, cholesterol-containing deposits build up over time, forming plaques in the heart's arteries. If a plaque ruptures, a blood clot can form. The clot can block arteries, causing a heart attack. During a heart attack, a lack of blood flow causes the tissue in the heart muscle to die. A heart attack is also called a myocardial infarction. Prompt treatment is needed for a heart attack to prevent death. Call 911 or emergency medical help if you think you might be having a heart attack. Symptoms Symptoms of a heart attack vary. Some people have mild symptoms. Others have severe symptoms. Some people have no symptoms. Common heart attack symptoms include:  Chest pain that may feel like pressure, tightness, pain, squeezing or aching Pain or discomfort that spreads to the shoulder, arm, back, neck, jaw, teeth or sometimes the upper belly Cold sweat Fatigue Heartburn or indigestion Lightheadedness or sudden dizziness Nausea Shortness of breath Women may have atypical symptoms such as brief or sharp pain felt in the neck, arm or back. Sometimes, the first symptom sign of a heart attack is sudden cardiac arrest. Some heart attacks strike suddenly. But many people have warning signs and symptoms hours, days or weeks in advance. Chest pain or pressure (angina) that keeps happening and doesn't go away with rest may be an early warning sign. Angina is caused by a temporary decrease in blood flow to the heart. When to see a doctor Get help right away if you think you're having a heart attack. Take these steps: Call for emergency medical help. If you think you're having a heart attack, immediately call 911 or your local emergency number. If you don't have access to emergency medical services, have someone drive you to the nearest hospital. Drive yourself only if there are no other options. Take nitroglycerin, if prescribed to you by a health care provider. Take it as instructed while awaiting emergency help. Take aspirin, if recommended. Taking aspirin during a heart attack may reduce heart damage by preventing blood clotting. Aspirin can interact with other drugs. Don't take an aspirin unless your care provider or emergency medical personnel say to do so. Don't delay calling 911 to take an aspirin. Call for emergency help first. What to do if you see someone who might be having a heart attack If someone is unconscious and you think they're having a heart attack, first call 911 or your local emergency number. Then check if the person is breathing and has a pulse. If the person isn't breathing or you don't find a pulse, only then should you begin cardiopulmonary resuscitation (CPR). If you're untrained in CPR, do hands-only CPR. That means push hard and fast on the person's chest — about 100 to 120 compressions a minute.  If you're trained in CPR and confident in your ability, start with 30 chest compressions before giving two rescue breaths. Causes Coronary artery disease causes most heart attacks. In coronary artery disease, one or more of the heart (coronary) arteries are blocked. This is usually due to cholesterol-containing deposits called plaques. Plaques can narrow the arteries, reducing blood flow to the heart. If a plaque breaks open, it can cause a blood clot in the heart. A heart attack may be caused by a complete or partial blockage of a heart (coronary) artery. One way to classify heart attacks is whether an electrocardiogram (ECG or EKG) shows some specific changes (ST elevation) that require emergency invasive treatment. Your health care provider may use electrocardiogram (ECG) results to describe these types of heart attacks. An acute complete blockage of a medium or large heart artery usually means you've had an ST elevation myocardial infarction (STEMI). A partial blockage often means you've had a non-ST elevation myocardial infarction (NSTEMI). However, some people with non-ST elevation myocardial infarction (NSTEMI) have a total blockage. Not all heart attacks are caused by blocked arteries. Other causes include: Coronary artery spasm. This is a severe squeezing of a blood vessel that's not blocked. The artery generally has cholesterol plaques or there is early hardening of the vessel due to smoking or other risk factors. Other names for coronary artery spasms are Prinzmetal's angina, vasospastic angina or variant angina. Certain infections. COVID-19 and other viral infections may cause damage to the heart muscle. Spontaneous coronary artery dissection (SCAD). This life-threatening condition is caused by a tear inside a heart artery. Risk factors Heart attack risk factors include: Age. Men age 45 and older and women age 55 and older are more likely to have a heart attack than are younger men and women. Tobacco use. This includes smoking and long-term exposure to secondhand smoke. If you smoke, quit. High blood pressure. Over time, high blood pressure can damage arteries that lead to the heart. High blood pressure that occurs with other conditions, such as obesity, high cholesterol or diabetes, increases the risk even more.  High cholesterol or triglycerides. A high level of low-density lipoprotein (LDL) cholesterol (the "bad" cholesterol) is most likely to narrow arteries. A high level of certain blood fats called triglycerides also increases heart attack risk. Your heart attack risk may drop if levels of high- density lipoprotein (HDL) cholesterol — the "good" cholesterol — are in the standard range. Obesity. Obesity is linked with high blood pressure, diabetes, high levels of triglycerides and bad cholesterol, and low levels of good cholesterol. Diabetes. Blood sugar rises when the body doesn't make a hormone called insulin or can't use it correctly. High blood sugar increases the risk of a heart attack. Metabolic syndrome. This is a combination of at least three of the following things: enlarged waist (central obesity), high blood pressure, low good cholesterol, high triglycerides and high blood sugar. Having metabolic syndrome makes you twice as likely to develop heart disease than if you don't have it. Family history of heart attacks. If a brother, sister, parent or grandparent had an early heart attack (by age 55 for males and by age 65 for females), you might be at increased risk. Not enough exercise. A lack of physical activity (sedentary lifestyle) is linked to a higher risk of heart attacks. Regular exercise improves heart health. Unhealthy diet. A diet high in sugars, animal fats, processed foods, trans fats and salt increases the risk of heart attacks. Eat plenty of fruits, vegetables, fiber and healthy oils. Stress. Emotional stress, such as extreme anger, may increase the risk of a heart attack. Illegal drug use. Cocaine and amphetamines are stimulants. They can trigger a coronary artery spasm that can cause a heart attack. A history of preeclampsia. This condition causes high blood pressure during pregnancy. It increases the lifetime risk of heart disease. An autoimmune condition. Having a condition such as rheumatoid arthritis or lupus can increase the risk of a heart attack. Complications Heart attack complications are often due to heart muscle damage. Potential complications of a heart attack include: Irregular or atypical heart rhythms (arrhythmias). Heart attack damage can affect how electrical signals move through the heart, causing heartbeat changes. Some may be serious and can be deadly. Cardiogenic shock. This rare condition occurs when the heart is suddenly and abruptly unable to pump blood.  Heart failure. A lot of damage to the heart muscle tissue can make the heart unable to pump blood. Heart failure can be temporary or long-lasting (chronic). Inflammation of the saclike tissue surrounding the heart (pericarditis). Sometimes a heart attack triggers a faulty immune system response. This condition may be called Dressler syndrome, postmyocardial infarction syndrome or postcardiac injury syndrome. Cardiac arrest. Without warning, the heart stops. A sudden change in the heart's signaling causes sudden cardiac arrest. A heart attack increases the risk of this life-threatening condition. It can lead to death (sudden cardiac death) without immediate treatment. Prevention It's never too late to take steps to prevent a heart attack — even if you've already had one. Here are ways to prevent a heart attack. Follow a healthy lifestyle. Don't smoke. Maintain a healthy weight with a heart-healthy diet. Get regular exercise and manage stress. Manage other health conditions. Certain conditions, such as high blood pressure and diabetes, can increase the risk of heart attacks. Ask your health care provider how often you need checkups. Take medications as directed. Your health care provider may prescribe drugs to protect and improve your heart health. It's also a good idea to learn CPR properly so you can help someone who's having a heart attack. Consider taking an accredited first-aid training course, including CPR and how to use an automated external defibrillator (AED). Diagnosis Ideally, a health care provider should screen you during regular checkups for risk factors that can lead to a heart attack. A heart attack is often diagnosed in an emergency setting. If you've had or are having a heart attack, care providers will take immediate steps to treat your condition. If you're able to answer questions, you may be asked about your symptoms and medical history. Diagnosis of a heart attack includes checking blood pressure, pulse and temperature. Tests are done to see how the heart is beating and to check overall heart health. Tests Tests to diagnose a heart attack include: Electrocardiogram (ECG or EKG). This first test done to diagnose a heart attack records electrical signals as they travel through the heart. Sticky patches (electrodes) are attached to the chest and  sometimes the arms and legs. Signals are recorded as waves displayed on a monitor or printed on paper. An electrocardiogram (ECG) can show if you are having or have had a heart attack. Blood tests. Certain heart proteins slowly leak into the blood after heart damage from a heart attack. Blood tests can be done to check for these proteins (cardiac markers). Chest X-ray. A chest X-ray shows the condition and size of the heart and lungs. Echocardiogram. Sound waves (ultrasound) create images of the moving heart. This test can show how blood moves through the heart and heart valves. An echocardiogram can help identify whether an area of your heart has been damaged. Coronary catheterization (angiogram). A long, thin tube (catheter) is inserted into an artery, usually in the leg, and guided to the heart. Dye flows through the catheter to help the arteries show up more clearly on images made during the test. Cardiac computed tomography (CT) or Magnetic resonance imaging (MRI). These tests create images of the heart and chest. Cardiac CT scans use X-rays. Cardiac MRI uses a magnetic field and radio waves to create images of your heart. For both tests, you usually lie on a table that slides inside a long tubelike machine. Each test can be used to diagnose heart problems. They can help show the severity of heart damage. Treatment Each minute after a heart attack, more heart tissue is damaged or dies. Urgent treatment is needed to fix blood flow and restore oxygen levels. Oxygen is given immediately. Specific heart attack treatment depends on whether there's a partial or complete blockage of blood flow. Medications Medications to treat a heart attack might include: Aspirin. Aspirin reduces blood clotting. It helps keep blood moving through a narrowed artery. If you called 911 or your local emergency number, you may be told to chew aspirin. Emergency medical providers may give you aspirin immediately. Clot busters (thrombolytics or fibrinolytics). These drugs help break up any blood clots that are blocking blood flow to the heart. The earlier a thrombolytic drug is given after a heart attack, the less the heart is damaged and the greater the chance of survival. Other blood-thinning medicines. A medicine called heparin may be given by an intravenous (IV) injection. Heparin makes the blood less sticky and less likely to form clots. Nitroglycerin. This medication widens the blood vessels. It helps improve blood flow to the heart. Nitroglycerin is used to treat sudden chest pain (angina). It's given as a pill under the tongue, as a pill to swallow or as an injection. Morphine. This medicine is given to relieve chest pain that doesn't go away with nitroglycerin.  Beta blockers. These medications slow the heartbeat and decrease blood pressure. Beta blockers can limit the amount of heart muscle damage and prevent future heart attacks. They are given to most people who are having a heart attack. Blood pressure medicines called angiotensin-converting enzyme (ACE) inhibitors. These drugs lower blood pressure and reduce stress on the heart. Statins. These drugs help lower unhealthy cholesterol levels. Too much bad (low-density lipoprotein, or LDL) cholesterol can clog arteries. Surgical and other procedures If you've had a heart attack, a surgery or procedure may be done to open a blocked artery. Surgeries and procedures to treat a heart attack include: Coronary angioplasty and stenting. This procedure is done to open clogged heart arteries. It may also be called percutaneous coronary intervention (PCI). If you've had a heart attack, this procedure is often done during a procedure to find blockages (cardiac catheterization). During angioplasty, a heart doctor (cardiologist) guides a thin, flexible tube (catheter) to the narrowed part of the heart artery. A tiny balloon is inflated to help widen the blocked artery and improve blood flow. A small wire mesh tube (stent) may be placed in the artery during angioplasty. The stent helps keep the artery open. It lowers the risk of the artery narrowing again. Some stents are coated with a medication that helps keep the arteries open. Coronary artery bypass grafting (CABG). This is open-heart surgery. A surgeon takes a healthy blood vessel from another part of the body to create a new path for blood in the heart. The blood then goes around the blocked or narrowed coronary artery. It may be done as an emergency surgery at the time of a heart attack. Sometimes it's done a few days later, after the heart has recovered a bit. Cardiac rehabilitation Cardiac rehabilitation is a personalized exercise and education program that teaches ways to improve heart health after heart surgery. It focuses on exercise, a heart-healthy diet, stress management and a gradual return to usual activities. Most hospitals offer cardiac rehabilitation starting in the hospital. The program typically continues for a few weeks or months after you return home. People who attend cardiac rehab after a heart attack generally live longer and are less likely to have another heart attack or complications from the heart attack. If cardiac rehab is not recommended during your hospital stay, ask your provider about it. Self care To improve heart health, take the following steps:  Exercise. Regular exercise helps improve heart health. As a general goal, aim for at least 30 minutes of moderate or vigorous physical activity five or more days a week. If you've had a heart attack or heart surgery, you may have activity restrictions. Ask your health care provider what's best for you. Eat a heart-healthy diet. Avoid or limit foods with a lot of saturated fat, trans fats, salt and sugar. Choose whole grains, fruits, vegetables, and lean proteins, such as fish and beans. Maintain a healthy weight. Too much weight strains the heart. Being overweight increases the risk of high cholesterol, high blood pressure and diabetes. Don't smoke. Quitting smoking is the most important thing you can do to improve heart health. Also, avoid being around secondhand smoke. If you need to quit, ask your provider for help. Limit alcohol. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men. Get regular health checkups. Some of the major risk factors for a heart attack — high blood cholesterol, high blood pressure and diabetes — don't cause early symptoms. Manage blood pressure, cholesterol and blood sugar. Ask your provider how often you need to have your blood pressure, blood sugar and cholesterol levels checked. Control stress. Find ways to help reduce emotional stress. Getting more exercise, practicing mindfulness and connecting with others in support groups are some ways to ease stress. MI non Stemi A non-ST-elevation myocardial infarction (NSTEMI) is a type of heart attack that usually happens when your heart’s need for oxygen can’t be met. This condition gets its name because it doesn’t have an easily identifiable electrical pattern (ST elevation) like the other main types of heart attacks. What is an NSTEMI heart attack? A non-ST-elevation myocardial infarction is a type of heart attack that happens when a part of your heart is not getting enough oxygen. This condition gets its name because — unlike an ST-elevation myocardial infarction (STEMI heart attack) — it doesn’t cause a very specific, recognizable change to your heart’s electrical activity. Why is it called an NSTEMI? The medical term for a heart attack is myocardial infarction. An infarction is a lack of blood flow to a part of your body, and myocardial means it’s happening in your heart muscle. Without enough blood flow, the affected part of your heart muscle starts to die. Your heart’s electrical activity is easily detectable by a test called an electrocardiogram. That test uses several sensors (usually 10) attached to your skin to detect your heart’s electrical activity. It then shows the electrical activity as a wave pattern on either a paper printout or a digital display. The wave pattern is also broken down into segments, with each part of the wave labeled with a letter of the alphabet from P to U. STEMI heart attacks are diagnosed when part of the wave, the ST segment, rises higher than normal. In most cases, a STEMI heart attack happens because of a total blockage of one of the main coronary arteries that provide blood flow to your heart muscle. People with symptoms of heart attack who don’t have ST elevation could have an NSTEMI, which usually happens because of a partial coronary artery blockage or blockage in a branch off of your main coronary artery. Some electrical pattern changes are often visible with NSTEMI, but they’re often not as distinctive, making other tests much more important in diagnosing NSTEMI. Who is affected by NSTEMIs? Several risk factors can increase your chances of a heart attack. Some of those factors can be modified, while others can’t. Factors you can change The factors you can manage most are your lifestyle choices. These include: Tobacco use and smoking. Diet, including your intake of sodium (blood pressure), sugar (diabetes) or fat (cholesterol). Your level of physical activity. Recreational drug use (especially stimulants like amphetamines, cocaine or any other medications that affect your heart). Factors you can’t change Age. Your age affects your risk of having a heart attack. The older you are, the greater the risk. Sex. Men tend to have heart attacks earlier than women. The risk for men starts going up at age 45, while for women, it starts going up at age 50 (or after you reach menopause, whichever is first). Family history. Your risk goes up sooner if you had a father or brother diagnosed with heart disease or heart attack before age 55, or a mother or sister similarly diagnosed before age 65. Inherited or conditions present at birth. Certain medical conditions or disorders that affect other systems in your body can also increase your risk of a heart attack. This includes genetic (inherited) or congenital (present at birth) conditions. Symptoms and Causes What happens before and during an NSTEMI? NSTEMI is a type of acute coronary syndrome, which is an umbrella term for three conditions that cause a lack of blood flow to your heart. The other two conditions are STEMI and unstable angina (sudden chest pain from lack of blood flow, usually while resting, but not as dangerous as a heart attack). Without a steady supply of blood, a problem called ischemia (pronounced iss-key-me-uh) happens. That means the affected part of your heart starts dying because it isn’t getting enough blood. Unlike other muscles, your heart muscle can’t regenerate or regrow. That means the damage will be permanent without quick restoration of blood flow. NSTEMI can happen because of direct or indirect causes, including those listed below. Conditions that are direct causes Several conditions can directly reduce your heart’s blood supply. Plaque. This wax-like substance comes from cholesterol in your blood. Much like a clogged pipe can cause a slow drain, plaque buildup can slow blood flow to your heart. Plaques in your arteries can also erode or split, which can cause blood clots to form on the plaque and rapidly (over minutes to hours) narrow down or close your artery. Vasospasm. There’s a lining of smooth muscle in your blood vessels that controls how narrow or wide those vessels are. Much like you can get cramps or spasms in the muscles of your legs or back, the muscle lining of the arteries of your heart can also spasm. Known as vasospasm, this can limit or block blood flow and cause a heart attack. These are rare. Coronary embolism. This is a blood clot that gets stuck in one of your heart's arteries and partially or completely stops blood flow. These are extremely rare. Injury or trauma to your heart Though your rib cage and other structures surround and protect your heart, injuries are still possible. Injury-related causes of NSTEMI include: Myocarditis. This is an inflammation of the muscle of your heart. A possible cause of this is an infection (usually viral) that’s affecting your heart muscle. Poisons and toxins. Certain substances have toxic effects and can damage the heart muscle, which can cause you to have a heart attack. This is rare overall. One of the most common ways this happens is because of carbon monoxide poisoning. Cardiac contusion. A contusion is a bruise, and a bruise of your heart muscle can cause swelling that leads to an NSTEMI. These are rare and usually only happen with major injuries such as those from car crashes. Indirect causes Several conditions can interfere with your body’s ability to supply blood and oxygen to your cells. When your body can’t supply enough blood to meet the demand, this can cause an NSTEMI. Conditions that disrupt blood supply include:  Severe high blood pressure (known as “malignant hypertension” or “hypertensive emergency”) and low blood pressure (hypotension). Your body naturally responds to low blood pressure by making your heart pump harder. High blood pressure can happen because your blood vessels have greater resistance to blood flow. In both situations, your heart tries to pump harder, and it needs more blood flow to maintain that level of effort. Tachycardia (fast heart rate). When part or all of your heart pumps too fast, it becomes less efficient and pumps less blood. The heart muscle may also need more oxygen than the blood flow can provide. Aortic stenosis. This condition is a narrowing of the aortic valve, the last valve that blood flows through before exiting your heart. In people with severe aortic stenosis, the heart muscle must work very hard to compensate for the narrowing, and may need more oxygen than blood flow can provide. Pulmonary embolism. This is when a blood clot gets stuck in your lungs, blocking blood from passing through and picking up oxygen before going back to your heart and out to your body. What are the symptoms? People having a heart attack commonly describe these symptoms: Chest pain (angina). Trouble breathing or feeling short of breath. Nausea, stomach discomfort or pain (may feel like indigestion or heartburn). Heart palpitations (the unpleasant feeling of your own heartbeat; may also feel like your heart is skipping or adding extra heartbeats). Feeling lightheaded, dizzy or passing out. Heart attack symptoms women may experience While women may experience any of the symptoms described above, they’re less likely to report symptoms of discomfort that feel like indigestion or pain in the center of their chest. They’re also more likely to report the following symptoms: Fatigue, shortness of breath or insomnia that began before the heart attack. Pain that radiates (spreads outward) to their jaw, neck, shoulders, arms, back or belly. Nausea and vomiting. Diagnosis and Tests How is this condition diagnosed? A physician diagnoses an NSTEMI based on a combination of tests and other types of information gathering. Combining these methods is especially important because an NSTEMI is more likely to have symptoms or test results that are less specific than those seen with STEMI or other conditions. The first step in this process is a direct examination, where a healthcare provider listens to your heart and breathing, checks your blood pressure and more. Then, if you’re medically stable and can answer questions, they’ll also gather a “patient history,” which includes details about your current lifestyle, personal circumstances and your medical history. What tests will be done to diagnose this condition? A heart attack diagnosis can involve the following tests. Electrocardiogram (EKG or ECG) An electrocardiogram is one of the most important ways to diagnose a heart attack. As described earlier, this test detects your heart’s electrical activity and shows it as a wave. A heart attack can cause changes in the pattern that trained medical professionals can interpret and use for a diagnosis. Where a STEMI causes the ST segment of the wave to be consistently taller, that doesn’t happen with an NSTEMI. Instead, the following changes may — but don’t always — show up on an EKG: Transient ST-elevation. This means that the ST segment does get taller, but it only stays that way for short periods. ST-depression. Under normal circumstances, the ST segment is usually even with the overall baseline of the wave. However, with an NSTEMI, the ST-segment may drop below its normal baseline position. New T-wave inversions. The T-wave is the last wave in the pattern, with the U-point marking the end of the T-wave, after which the pattern starts over again at the next heartbeat’s P-point. New T-wave inversion means that if your T-waves normally curve upward (like a hill), they now curve downward (like a bowl). Lab testing When there’s damage to your heart muscle cells or they die for any reason, they release a unique chemical called troponin. That chemical is detectable with blood tests, making those tests one of the most reliable ways to diagnose any kind of heart attack. However, it might be necessary to repeat a troponin test because it can take time to reach detectable levels (usually fewer than six hours). Imaging Using imaging tests may also help with a diagnosis, especially if earlier tests were inconclusive. Some of these tests may involve exercise to try to provoke symptoms that were undetectable when you were resting. Some of the most common imaging tests used include: Echocardiography. This test uses ultra-high-frequency sound waves to create an image of the inside and outside of your heart. This test is often used in emergency rooms because the equipment can travel on a mobile cart for use at the bedside. Computed tomography (CT) scan. This test uses X-rays to take images, and then a computer assembles the images into a complete three-dimensional picture. This might involve an  injectable substance that shows up clearly on the scan, which will allow healthcare providers to identify plaque or narrowing in your coronary arteries that provide blood flow to your heart muscle. Magnetic resonance imaging (MRI). This test uses an extremely powerful magnet and computer processing to create extremely detailed scans of your heart. Management and Treatment What treatments are used with NSTEMIs? Treatment of all heart attacks is time-sensitive, and the faster the restoration of blood flow happens, the better. Oxygen may help if your blood oxygen levels are low, but this varies from person to person. Several other treatments and techniques are possible, some of them in sequence or at the same time. Percutaneous coronary intervention (PCI) Percutaneous coronary intervention is a procedure where an interventional cardiologist inserts a catheter device into a major blood vessel somewhere in your body (usually in your wrist or near your upper thigh). They then thread that device up to your heart and your artery in question. Once there, they inflate a balloon at the device’s tip, helping clear the blockage. Stent placement, which uses a scaffold-like device to help hold the blood vessel open, is also possible and common during PCI. PCI works best when done sooner rather than later. Medication Several medications (some of which you’ll take before diagnosis confirmation) can help people who are having a heart attack. These include: Aspirin or other antiplatelet medications. These drugs stop platelets from bunching together and forming clots in your blood. That’s important because it stops clot-based blockages from getting worse. Anticoagulants. Like antiplatelet medications, these also interfere with clotting, but do so by interfering with the clotting process itself rather than the platelets. Angiotensin-converting enzyme (ACE) inhibitors. These medications interfere with your body’s natural conversion of a protein that raises your blood pressure. Blocking that process lowers your blood pressure. Use of these drugs is more likely if you have heart failure, high blood pressure, kidney problems or diabetes. Beta-blockers. These medications slow down your heart rate and cause your heart to pump with less force. Both effects are important because they reduce how much oxygen your heart needs by easing how hard it works. These medications might not be an option if you have conditions like low blood pressure, heart failure or certain types of heart rhythm problems (arrhythmias). Nitroglycerin. This medication causes blood vessels to widen, which improves blood flow. That means, this drug is especially effective at treating chest pain caused by a lack of blood flow.  Statins. These medications lower how much cholesterol is in your blood and reduce the risk that plaque in your coronary arteries will worsen. Coronary artery bypass grafting (CABG) In cases where one or more of your heart’s arteries has significant narrowing or blockage, surgery may be a better option to restore blood flow. This surgery is known as coronary artery bypass grafting (often shortened to CABG, pronounced “cabbage”). Its other names include bypass surgery or open-heart surgery. During CABG, a surgeon takes a blood vessel from somewhere else in your body (such as one of your legs or the inside of your chest wall). They then use that blood vessel to create a bypass around your heart’s blocked artery (or arteries). That allows blood flow to “bypass” the problem area. Prevention Can I prevent a heart attack? There are several things you can do to help prevent a heart attack, or at least delay one. One key thing is to schedule a physical (also called a checkup or wellness visit) with your primary care provider. Many health conditions — such as high blood pressure and diabetes — don’t cause symptoms until they’re very advanced. Before symptoms appear, however, these conditions can cause ongoing damage to your heart and coronary arteries, and greatly increase your risk of having a heart attack. But these conditions are easily detectable early on with simple, non-invasive tests done during your yearly visit. Your healthcare provider can also offer guidance and resources if they do find any potential problems or concerns. Some of the best things you can do to avoid a heart attack include: Maintaining a healthy weight. Eating a balanced diet (your healthcare provider can recommend diets, such as the Mediterranean diet, that work especially well for heart health). Staying physically active (at least 150 minutes per week of moderate-intensity exercise). Managing health conditions you already have. If you take medications for any conditions, be sure to keep taking them exactly as instructed. If you use tobacco in any form (including vaping products), quitting will be especially helpful in preventing a heart attack. Unfortunately, some people may experience a heart attack even if they take all these preventive steps, particularly if they’re prone to heart attacks due to family history or another condition. However, you may be able to postpone when you have a heart attack or make it less severe if you follow the above guidelines. Being in good health also tends to make recovery easier and improves your overall outlook after a heart attack. MI STEMI An ST-elevation myocardial infarction (STEMI) is a type of heart attack that mainly affects your heart’s lower chambers. They are named for how they change the appearance of your heart’s electrical activity on a certain type of diagnostic test. STEMIs tend to be more severe and dangerous compared to other types of heart attack. What is a STEMI? An ST-elevation myocardial infarction (STEMI) is a type of heart attack that is more serious and has a greater risk of serious complications and death. It gets its name from how it mainly affects the heart’s lower chambers and changes how electrical current travels through them. Why is it called a STEMI? Myocardial infarction is the medical term for a heart attack. An infarction is a blockage of blood flow to the myocardium, the heart muscle. That blockage causes the heart muscle to die. A STEMI is a myocardial infarction that causes a distinct pattern on an electrocardiogram (abbreviated either as ECG or EKG). This is a medical test that uses several sensors (usually 10) attached to your skin that can detect your heart’s electrical activity. That activity is then displayed as a wave pattern on a paper readout or a digital display. The different parts of the wave are labeled using letters, starting at P and ending at U. To best understand ST-elevation, it helps to know about two specific wave sections: QRS complex: This is the large peak that appears on a heart wave. The ventricles cause this wave when they pump blood out of your heart. ST-segment: This is a short section immediately after the QRS complex. Normally, there shouldn’t be any electrical activity in that segment, causing it to be flat and back to baseline. When there’s an elevation in the ST segment, that often means there’s a total blockage of one of the heart's main supply arteries. When that is happening during a heart attack, it can be a sign that the muscle of the ventricles is dying. That’s critical information for healthcare providers to know during a STEMI because it means the heart muscle is in the process of dying. That also means reopening that artery and restoring blood flow as soon as possible may prevent permanent damage, or at least limit the severity of the damage. That’s dangerous because the ventricles are the chambers of your heart that pump blood to your lungs and body. If there’s too much damage to the muscle in the ventricles, your heart can’t pump enough blood to support your body. That’s why STEMIs are so dangerous and why restoring blood flow quickly is so critical. Your heart muscle also can’t regrow or regenerate itself, so if the muscle goes without blood flow for too long, the damage to that muscle can be permanent. However, restoring blood flow quickly may keep the damage from being permanent or at least minimize the severity of the damage. What happens before and during a STEMI heart attack? Blockages in the arteries that supply blood to your heart muscle are what cause most heart attacks. Usually, the blockage happens because plaque, a fatty, waxy buildup accumulates on the inside of your arteries. A blood clot can form on the plaque deposits, rapidly closing the artery and interrupting blood flow to the heart muscle. Once blood flow is partially or totally blocked, it causes ischemia (iss-key-me-uh). This is the medical term for how your cells and tissues start to die because they aren't getting blood flow. During a heart attack, the loss of blood flow causes the muscle in your ventricles to begin to die. If too much heart muscle sustains damage, your heart may not have the ability to supply enough blood to your body. That leads to a condition known as cardiogenic shock, which is often fatal. Also, ischemia of the heart muscle may also trigger a dangerous electrical rhythm known as ventricular tachycardia or ventricular fibrillation, which can lead to cardiac arrest (where your heart stops entirely) and sudden death. Among heart attacks, STEMIs are typically more severe. Between 2.5% and 10% of people who have one die within 30 days. Acute coronary syndrome STEMI is one of three conditions that fall under acute coronary syndrome, a disease that happens because of limited or no blood flow to a part of your heart. The other two conditions are non-ST elevation heart attacks (NSTEMI) and unstable angina (sudden chest pain, usually while resting, caused by limited blood flow to the heart). Anterior and inferior or lateral STEMI There are three coronary arteries that provide blood flow to your heart muscle. Depending on which arteries contain the blockage, damage will happen in different areas of the heart muscle. Anterior STEMI. This type of STEMI usually occurs when a blockage occurs in the left anterior descending (LAD) artery, the largest artery which provides blood flow to the anterior (front) side of your heart. Because the LAD is so large and feeds so much heart muscle, a heart attack affecting this area has a much greater negative effect. Inferior or lateral STEMI. These types of STEMI usually involve the right coronary artery (RCA), which supplies the inferior (bottom) side of your heart, or the left circumflex (LCX) artery which supplies the side wall of your heart. The RCA and LCX are usually smaller than the LAD and supply less heart muscle, so these STEMIs are slightly less severe than anterior STEMI. What is the difference between a STEMI and a non-STEMI heart attack? The key characteristic that identifies a STEMI is the ST-segment elevation. ST-segment elevation usually indicates a total blockage of the involved coronary artery and that the heart muscle is currently dying. Non-STEMI heart attacks usually involve an artery with partial blockage, which usually does not cause as much heart muscle damage. While ECG results can suggest an NSTEMI, diagnosis usually requires a test that looks for a certain chemical, troponin, in your blood. When there’s damage to your heart muscle, those cells release troponin into your blood. If the blood test detects troponin and you don't have ST- segment elevation, this means it's likely you had a non-ST-elevation heart attack or NSTEMI. Who is affected by STEMIs? Several risk factors increase the chances of having a heart attack. You can change some of those factors, but not others. Factors you can change You can manage or modify lifestyle factors. These include: Tobacco use and smoking. Diet, including your intake of sodium (blood pressure), sugar (diabetes) or fat (cholesterol). Your level of physical activity. Alcohol use. Drug use (especially stimulants like amphetamines, cocaine or any other medications that affect your heart). Factors you can’t change These factors include: Age. Your risk of heart attack goes up as you get older. Sex. Men's heart attack risk starts going up at age 45. Women's heart attack risk increases at age 50 or after menopause (whichever comes first). Family history. If you have a parent or sibling who had a heart attack at your age or younger, your risk goes up significantly. It also includes if you had a father or brother diagnosed with heart disease before age 55 or a mother or sister diagnosed before age 65. Genetic or congenital conditions. Certain medical conditions or disorders can increase your risk of a heart attack. If you inherited these conditions (genetic) or were born with them (congenital), they can’t be changed. Symptoms and Causes What are the symptoms? The most common symptoms of heart attack, described by those having one, include: Chest pain (angina). Shortness of breath or trouble breathing. Nausea, stomach pain or discomfort. It may feel like indigestion in some cases. Heart palpitations (where you’re unpleasantly aware of your heartbeat). Anxiety or a feeling of impending doom. Sweating.  Feeling dizzy, lightheaded or fainting. Heart attack symptoms in women Women are less likely to say they have pain in the center of the chest or discomfort that feels like indigestion. Heart attack symptoms that women experience can often be those listed above but may also include: Insomnia, fatigue or shortness of breath that started in advance of the heart attack. Pain that spreads (or radiates) to their back, shoulders, jaw, neck, arms or belly. Nausea and vomiting. Diagnosis and Tests How is this condition diagnosed? A physician will diagnose STEMI based on a combination of physical examination of your symptoms and diagnostic tests. Once you're medically stable, and if you're able to answer questions, a provider can do a physical examination and patient history assessment (where the doctor asks you questions about your medical history and personal circumstances). What tests will be done to diagnose this condition? Tests done to confirm or rule out a heart attack diagnosis include: Electrocardiogram (EKG): This test, which shows electrical activity in the heart like a wave pattern (described above), is key to diagnosing a STEMI. Imaging: The most common imaging test used with suspected heart attacks is echocardiography. This test uses ultra-high-frequency sound waves to create an image of your heart, including the internal structure. This is also mobile and doable without moving you from a hospital bed, making it especially useful and fast in emergencies. Other imaging tests are also possible, especially when EKG or other tests are inconclusive but there’s still enough reason to suspect a heart attack. Use of the following tests is also possible: Computed tomography (CT) scan: This test uses X-rays and computer processing to generate a highly detailed, layer-by-layer view of the heart. This test is often done with contrast or some other kind of substance or dye that’s added to your blood. This dye can help show where blood is flowing and where it isn’t, helping diagnose any blockages. Magnetic resonance imaging (MRI): This test uses an extremely powerful magnet and a computer to process images and create high-resolution pictures of the heart. Lab testing: Damage to your heart’s cells causes them to release a chemical called troponin. A troponin test can help confirm a heart attack, which is important because a few other conditions can cause ST elevation. Some of those conditions include: Inflammation of the heart or the pericardium (the sac around the heart).  Heart problems caused by extreme stress or emotional strain (takotsubo cardiomyopathy, also known as broken heart syndrome). Irregular heart rhythms (arrhythmias). Electrolyte imbalances. Management and Treatment How is STEMI treated? Treating a STEMI is time-sensitive. That means the faster the treatment, the better the chances for a favorable outcome. If your blood oxygen levels are low, treatment may include supplemental oxygen. There are also several different potential treatments for heart attack, several of which may happen in sequence or at the same time. Percutaneous coronary intervention (PCI) An interventional cardiologist performs this treatment, inserting a catheter-based device into a major blood vessel (usually in your wrist or near your upper thigh). They then thread the catheter up to your heart. Once there, the cardiologist injects contrast (“dye”) into your arteries to identify a blockage and may then inflate a balloon on the end of the catheter to clear the blockage. PCI is time-sensitive, which is why hospitals set a “door-to-balloon time” goal for heart attack cases. This is the time it takes for a patient to go from entering the ER to undergoing PCI, and faster is better. During PCI, placement of a stent (a scaffold-like device at the location of the blockage) is also possible. The stent will help hold the artery open and prevent another blockage from forming. Medication In most cases, several medications are given early on in the treatment of heart attack. They include: Beta-blockers. These reduce how hard your heart pumps and slow down your heart rate. That effect helps the heart muscle handle reduced blood supply, prevent irregular heart rhythms and reduce damage to your heart. Statins. These medications lower the levels of cholesterol in your blood by block its production in the liver. This is important because cholesterol (especially at higher levels) is what forms plaque that can obstruct arteries. Aspirin and antiplatelet medications. These medications help reduce the formation of blood clots on the plaque in the arteries and, if stent placement happens during PCI, on the metal surface of the stent itself. Anticoagulants. These medications also interfere with clotting but do so in a slightly different way from antiplatelet drugs and aspirin. Nitroglycerin. This medication is very effective at vasodilation, meaning it causes your blood vessels to widen. That’s why it’s so effective at helping with chest pain from blockages of blood vessels.  Pain medications. When chest pain is severe, morphine or other strong pain medications may help. Coronary artery bypass grafting (CABG) surgery Severe blockages of your heart's arteries may need coronary artery bypass grafting (CABG, pronounced like "cabbage). During this procedure, a surgeon takes a blood vessel from somewhere else in your body and uses it to craft a new blood vessel that bypasses the blockage. CABG is often called bypass surgery or open-heart surgery. Prevention Can I prevent a heart attack? There are several things you can do that will help prevent a heart attack. Perhaps the most important of them is to get a yearly physical. This annual visit with your primary care provider (sometimes called a checkup or wellness visit) is one of the most important ways to catch problems early. Conditions like high blood pressure or diabetes may not cause symptoms until they're advanced, but a healthcare provider can easily catch them during an annual checkup. There are several other steps — many of which your primary care provider can offer guidance and resources about — that you can take: Maintain a healthy weight. Eat a balanced diet. Get at least 150 minutes per week of moderate-intensity exercise (or higher). If you use tobacco products, quit as soon as possible. Manage your health, especially conditions like high cholesterol, high blood pressure and diabetes (this includes taking your medication regularly, not just when you remember). However, because of the factors that you can’t change — especially your age and family history — preventing a heart attack isn’t always possible. Even so, it may be possible to delay when a heart attack happens. Recovering from a heart attack — or virtually any illness, for that matter — is also easier when you’re healthy. Pulmonary failure Respiratory failure is a condition where there’s not enough oxygen or too much carbon dioxide in your body. It can happen all at once (acute) or come on over time (chronic). Many underlying conditions can cause it. Acute respiratory failure is life-threatening. Call 911 or go to the nearest ER if you think you’re experiencing respiratory failure. What is respiratory failure? Respiratory failure is a condition where you don’t have enough oxygen in the tissues in your body (hypoxia) or when you have too much carbon dioxide in your blood (hypercapnia). You might also hear people use the term “acute hypoxemic respiratory failure (AHRF)” to describe it. Respiratory failure is often a medical emergency. Call 911 or seek medical attention right away if you think you’re experiencing respiratory failure. How respiration works You can think of respiration as passengers traveling from the air to your tissues. When you breathe in, oxygen molecules travel to your lungs — the passengers arriving at the airport. The oxygen passengers arrive at the “airport gates” — small air sacs around your lungs called alveoli — and are picked up by your blood. They travel through your blood to their final destination in your tissues, like your organs and muscles. You need oxygen to reach its destination to stay alive. After your blood cells drop off oxygen in your tissues, they have room to pick up carbon dioxide. Your body doesn’t need carbon dioxide (it’s a waste product). If too much of it builds up, there isn’t room in your blood’s transportation system to deliver oxygen. Your blood circulates through your body, back to your lungs, where it drops off carbon dioxide. When you breathe out, you get rid of the unnecessary waste to make room for more oxygen. If any parts of this system fail, you won’t have enough oxygen to keep your tissues healthy. What are the types of respiratory failure? Respiratory failure can come on suddenly (acute) or over time (chronic). There are two common types: hypoxemic respiratory failure (type 1) and hypercapnic respiratory failure (type 2). Other types include perioperative (related to surgery) respiratory failure (type 3) and respiratory failure due to shock (type 4). Hypoxemic respiratory failure Hypoxemic respiratory failure happens when you don’t have enough oxygen in your blood (hypoxemia). Heart and lung conditions are the most common causes. Hypoxemic respiratory failure is also called hypoxic respiratory failure. Hypercapnic respiratory failure Hypercapnic respiratory failure happens when you have too much carbon dioxide (CO2) in your blood. If your body can’t get rid of carbon dioxide, a waste product, there isn’t room for your blood cells to carry oxygen. The most common causes of hypercapnic respiratory failure include heart, lung, muscle and neurological (brain and spinal cord) conditions. Certain medications can also cause it. Hypercapnic respiratory failure is also called hypercarbic respiratory failure. Perioperative respiratory failure Perioperative respiratory failure can happen when you have surgery. Anesthesia (medication that keeps you asleep) can keep you from breathing properly. Sometimes, air sacs in your lungs can collapse (atelectasis) and keep oxygen from getting into your blood. Respiratory failure due to shock Shock is a condition that causes low blood pressure, fluid in your lungs (pulmonary edema) and other issues that can lead to respiratory failure. Sepsis, cardiac events (like a heart attack) and blood loss can cause shock. Symptoms and Causes What are the symptoms of respiratory failure? Symptoms of respiratory failure depend on the cause. Symptoms may include: Shortness of breath or feeling like you can’t get enough air (dyspnea). Rapid breathing (tachypnea). Extreme tiredness (fatigue). Fast heart rate (feeling like your heart’s racing) or heart palpitations. Spitting or coughing blood or bloody mucus (hemoptysis). Excessive sweating. Restlessness. Pale skin. Bluish skin, lips or nails (cyanosis). Headaches. Blurred vision. Agitation, confusion or being unable to think straight. Behavioral changes, not acting like yourself. What causes respiratory failure? Respiratory failure happens when something keeps your body from getting oxygen into your blood or getting carbon dioxide out of your blood. This can be due to: Too little airflow or blood flow to your lungs. Blockages, scarring or fluid in your lungs. Inability to breathe properly or deeply enough. Conditions that affect your lungs, issues with the nerves or muscles you use to breathe, or injuries to your chest can cause this. Abnormalities in the way blood flows through your heart. Risk factors for respiratory failure Risk factors for respiratory failure include:  Lung conditions and diseases. This includes acute respiratory distress syndrome (ARDS), chronic obstructive pulmonary disease (COPD), pneumonia, asthma, cystic fibrosis, pulmonary edema, pulmonary embolism and pulmonary fibrosis. Heart or circulatory (blood flow) conditions and diseases. This includes heart attack, congenital heart disease, heart failure and shock. Conditions that affect the nerves and muscles that help you breathe. This includes muscular dystrophy, amyotrophic lateral sclerosis (ALS), severe scoliosis and Guillain-Barré syndrome. Chest, spinal cord or brain injuries (including stroke). Smoking or exposure to other lung irritants. This includes chemical fumes, dust, air pollution and asbestos. Surgery that requires sedation or anesthesia. Drug use or excessive alcohol consumption. Age. Newborn babies (especially premature infants) and adults over 65 are at higher risk for respiratory failure. Diagnosis and Tests How is respiratory failure diagnosed? A provider diagnoses respiratory failure by testing the amount of oxygen and carbon dioxide in your blood. They’ll check your blood pressure and use a small device (pulse oximeter, or pulse ox) on your finger to check your oxygen levels. They’ll listen to your heart and lungs and examine you. You may need further tests if your provider thinks you have respiratory failure. What tests will be done to diagnose respiratory failure? Your provider may perform some or all of the following tests to help diagnose respiratory failure: Pulse oximetry: A sensor slips over your finger to measure the amount of oxygen in your blood. Providers often check this each time you visit. Arterial blood gas (ABG) test: A needle is used to take a blood sample from your wrist, arm or groin to measure the levels of oxygen and carbon dioxide in your blood. Lung function tests. Also called pulmonary function tests (PFT), your provider may have you breathe into a mouthpiece attached to a machine to test how well your lungs work. Imaging. Your provider may use X-rays and CT scans to get images of the inside of your body. These don’t diagnose respiratory failure, but they can help your provider know what’s causing it. Electrocardiogram (EKG). An EKG tests how well your heart is working. If your provider thinks a heart condition is causing respiratory failure, they may have you get an EKG. Management and Treatment How is respiratory failure treated? How providers treat respiratory failure depends on how severe it is and what’s causing it. Treatments focus on managing the underlying cause, giving you more oxygen, or using mechanical ventilation to breathe for you until you’re able to on your own again. Acute respiratory failure is an emergency and needs to be treated right away. Mild chronic respiratory failure can often be treated at home by managing the condition that’s causing it. Specific treatments for respiratory failure Providers may use medications or procedures to treat respiratory failure, including: Mechanical ventilation. Providers use a breathing machine and a tube that goes into your airways to move air in and out of your lungs. Extracorporeal membrane oxygenation (ECMO). Providers use a bypass machine to add oxygen to your blood and remove carbon dioxide. Oxygen therapy. A machine delivers extra oxygen through a breathing mask or small tube (cannula). You may get oxygen at home or in the hospital. Fluids. Your provider can give you fluids through an IV (directly to a vein). This can improve the blood flow through your body, bringing more oxygen to your tissues. Managing underlying conditions. You provider may treat you with other medications or procedures, depending on what’s causing respiratory failure. Prevention Can respiratory failure be prevented? You can’t always prevent respiratory failure. You can lower your risk of chronic respiratory failure by managing ongoing heart, lung and neurological conditions. Talk to your healthcare provider about ways to reduce your risk if you have a condition that can cause respiratory failure. CVA An ischemic stroke occurs when the blood supply to part of the brain is blocked or reduced. This prevents brain tissue from getting oxygen and nutrients. Brain cells begin to die in minutes. Another type of stroke is a hemorrhagic stroke. It occurs when a blood vessel in the brain leaks or bursts and causes bleeding in the brain. The blood increases pressure on brain cells and damages them. A stroke is a medical emergency. It's crucial to get medical treatment right away. Getting emergency medical help quickly can reduce brain damage and other stroke complications. The good news is that fewer Americans die of stroke now than in the past. Effective treatments also can help prevent disability from stroke. Symptoms If you or someone you're with may be having a stroke, pay attention to the time the symptoms began. Some treatments are most effective when given soon after a stroke begins. Symptoms of stroke include: Trouble speaking and understanding what others are saying. A person having a stroke may be confused, slur words or may not be able to understand speech. Numbness, weakness or paralysis in the face, arm or leg. This often affects just one side of the body. The person can try to raise both arms over the head. If one arm begins to fall, it may be a sign of a stroke. Also, one side of the mouth may droop when trying to smile. Problems seeing in one or both eyes. The person may suddenly have blurred or blackened vision in one or both eyes. Or the person may see double. Headache. A sudden, severe headache may be a symptom of a stroke. Vomiting, dizziness and a change in consciousness may occur with the headache. Trouble walking. Someone having a stroke may stumble or lose balance or coordination. When to see a doctor Seek immediate medical attention if you notice any symptoms of a stroke, even if they seem to come and go or they disappear completely. Think "FAST" and do the following: Face. Ask the person to smile. Does one side of the face droop? Arms. Ask the person to raise both arms. Does one arm drift downward? Or is one arm unable to rise? Speech. Ask the person to repeat a simple phrase. Is the person's speech slurred or different from usual? Time. If you see any of these signs, call 911 or emergency medical help right away. Causes There are two main causes of stroke. An ischemic stroke is caused by a blocked artery in the brain. A hemorrhagic stroke is caused by leaking or bursting of a blood vessel in the brain. Some people may have only a temporary disruption of blood flow to the brain, known as a transient ischemic attack (TIA). A TIA doesn't cause lasting symptoms. This is the most common type of stroke. It happens when the brain's blood vessels become narrowed or blocked. This causes reduced blood flow, known as ischemia. Blocked or narrowed blood vessels can be caused by fatty deposits that build up in blood vessels. Or they can be caused by blood clots or other debris that travel through the bloodstream, most often from the heart. An ischemic stroke occurs when fatty deposits, blood clots or other debris become lodged in the blood vessels in the brain. Some early research shows that COVID-19 infection may increase the risk of ischemic stroke, but more study is needed. Hemorrhagic stroke Hemorrhagic stroke occurs when a blood vessel in the brain leaks or ruptures. Bleeding inside the brain, known as a brain hemorrhage, can result from many conditions that affect the blood vessels. Factors related to hemorrhagic stroke include: High blood pressure that's not under control. Overtreatment with blood thinners, also known as anticoagulants. Bulges at weak spots in the blood vessel walls, known as aneurysms. Head trauma, such as from a car accident. Protein deposits in blood vessel walls that lead to weakness in the vessel wall. This is known as cerebral amyloid angiopathy. Ischemic stroke that leads to a brain hemorrhage. A less common cause of bleeding in the brain is the rupture of an arteriovenous malformation (AVM). An AVM is an irregular tangle of thin-walled blood vessels. Transient ischemic attack A transient ischemic attack (TIA) is a temporary period of symptoms similar to those of a stroke. But a TIA doesn't cause permanent damage. A TIA is caused by a temporary decrease in blood supply to part of the brain. The decrease may last as little as five minutes. A transient ischemic attack is sometimes known as a ministroke. A TIA occurs when a blood clot or fatty deposit reduces or blocks blood flow to part of the nervous system. Seek emergency care even if you think you've had a TIA. It's not possible to tell if you're having a stroke or TIA based only on the symptoms. If you've had a TIA, it means you may have a partially blocked or narrowed artery leading to the brain. Having a TIA increases your risk of having a stroke later. Risk factors Many factors can increase the risk of stroke. Potentially treatable stroke risk factors include: Lifestyle risk factors Being overweight or obese. Physical inactivity. Heavy or binge drinking. Use of illegal drugs such as cocaine and methamphetamine. Medical risk factors  High blood pressure. Cigarette smoking or secondhand smoke exposure. High cholesterol. Diabetes. Obstructive sleep apnea. Cardiovascular disease, including heart failure, heart defects, heart infection or irregular heart rhythm, such as atrial fibrillation. Personal or family history of stroke, heart attack or transient ischemic attack. COVID-19 infection. Other factors associated with a higher risk of stroke include: Age — People age 55 or older have a higher risk of stroke than do younger people. Race or ethnicity — African American and Hispanic people have a higher risk of stroke than do people of other races or ethnicities. Sex — Men have a higher risk of stroke than do women. Women are usually older when they have strokes, and they're more likely to die of strokes than are men. Hormones — Taking birth control pills or hormone therapies that include estrogen can increase risk. Complications A stroke can sometimes cause temporary or permanent disabilities. Complications depend on how long the brain lacks blood flow and which part is affected. Complications may include: Loss of muscle movement, known as paralysis. You may become paralyzed on one side of the body. Or you may lose control of certain muscles, such as those on one side of the face or one arm. Trouble talking or swallowing. A stroke might affect the muscles in the mouth and throat. This can make it hard to talk clearly, swallow or eat. You also may have trouble with language, including speaking or understanding speech, reading or writing. Memory loss or trouble thinking. Many people who have had strokes experience some memory loss. Others may have trouble thinking, reasoning, making judgments and understanding concepts. Emotional symptoms. People who have had strokes may have more trouble controlling their emotions. Or they may develop depression. Pain. Pain, numbness or other feelings may occur in the parts of the body affected by stroke. If a stroke causes you to lose feeling in the left arm, you may develop a tingling sensation in that arm.  Changes in behavior and self-care. People who have had strokes may become more withdrawn. They also may need help with grooming and daily chores. Prevention You can take steps to prevent a stroke. It's important to know your stroke risk factors and follow the advice of your healthcare professional about healthy lifestyle strategies. If you've had a stroke, these measures might help prevent another stroke. If you have had a transient ischemic attack (TIA), these steps can help lower your risk of a stroke. The follow-up care you receive in the hospital and afterward also may play a role. Many stroke prevention strategies are the same as strategies to prevent heart disease. In general, healthy lifestyle recommendations include: Control high blood pressure, known as hypertension. This is one of the most important things you can do to reduce your stroke risk. If you've had a stroke, lowering your blood pressure can help prevent a TIA or stroke in the future. Healthy lifestyle changes and medicines often are used to treat high blood pressure. Lower the amount of cholesterol and saturated fat in your diet. Eating less cholesterol and fat, especially saturated fats and trans fats, may reduce buildup in the arteries. If you can't control your cholesterol through dietary changes alone, you may need a cholesterol-lowering medicine. Quit tobacco use. Smoking raises the risk of stroke for smokers and nonsmokers exposed to secondhand smoke. Quitting lowers your risk of stroke. Manage diabetes. Diet, exercise and losing weight can help you keep your blood sugar in a healthy range. If lifestyle factors aren't enough to control blood sugar, you may be prescribed diabetes medicine. Maintain a healthy weight. Being overweight contributes to other stroke risk factors, such as high blood pressure, cardiovascular disease and diabetes. Eat a diet rich in fruits and vegetables. Eating five or more servings of fruits or vegetables every day may reduce the risk of stroke. The Mediterranean diet, which emphasizes olive oil, fruit, nuts, vegetables and whole grains, may be helpful. Exercise regularly. Aerobic exercise reduces the risk of stroke in many ways. Exercise can lower blood pressure, increase the levels of good cholesterol, and improve the overall health of the blood vessels and heart. It also helps you lose weight, control diabetes and reduce stress. Gradually work up to at least 30 minutes of moderate physical activity on most or all days of the week. The American Heart association recommends getting 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous aerobic activity a week. Moderate intensity activities can include walking, jogging, swimming and bicycling. Drink alcohol in moderation, if at all. Drinking large amounts of alcohol increases the risk of high blood pressure, ischemic strokes and hemorrhagic strokes. Alcohol also may interact with other medicines you're taking. However, drinking small to moderate amounts of alcohol may help prevent ischemic stroke and decrease the blood's clotting tendency. A small to moderate  amount is about one drink a day. Talk to your healthcare professional about what's appropriate for you. Treat obstructive sleep apnea (OSA). OSA is a sleep disorder that causes you to stop breathing for short periods several times during sleep. Your healthcare professional may recommend a sleep study if you have symptoms of OSA. Treatment includes a device that delivers positive airway pressure through a mask to keep the airway open while you sleep. Don't use illicit drugs. Certain illicit drugs such as cocaine and methamphetamine are established risk factors for a TIA or a stroke. Preventive medicines If you have had an ischemic stroke, you may need medicines to help lower your risk of having another stroke. If you have had a TIA, medicines can lower your risk of having a stroke in the future. These medicines may include: Anti-platelet drugs. Platelets are cells in the blood that form clots. Anti-platelet medicines make these cells less sticky and less likely to clot. The most commonly used anti-platelet medicine is aspirin. Your healthcare professional can recommend the right dose of aspirin for you. If you've had a TIA or minor stroke, you may take both an aspirin and an anti-platelet medicine such as clopidogrel (Plavix). These medicines may be prescribed for a period of time to reduce the risk of another stroke. If you can't take aspirin, you may be prescribed clopidogrel alone. Ticagrelor (Brilinta) is another anti-platelet medicine that can be used for stroke prevention. Blooding-thinning medicines, known as anticoagulants. These medicines reduce blood clotting. Heparin is a fast-acting anticoagulant that may be used short-term in the hospital. Slower acting warfarin (Jantoven) may be used over a longer term. Warfarin is a powerful blood-thinning medicine, so you need to take it exactly as directed and watch for side effects. You also need regular blood tests to monitor warfarin's effects. Several newer blood-thinning medicines are available to prevent strokes in people who have a high risk. These medicines include dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis) and edoxaban (Savaysa). They work faster than warfarin and usually don't require regular blood tests or monitoring by your healthcare professional. These medicines also are associated with a lower risk of bleeding complications compared to warfarin Diagnosis During a stroke, things move quickly once you get to the hospital. Your emergency team works to learn what type of stroke you're having. You'll likely have a CT scan or other imaging test soon after arrival. Healthcare professionals also need to rule out other possible causes of your symptoms, such as a brain tumor or a drug reaction. Some of the tests you may have include:  A physical exam. A healthcare professional does several tests, including listening to your heart and checking your blood pressure. A neurological exam looks at how a potential stroke is affecting your nervous system. Blood tests. You may need tests to check how fast your blood clots and whether your blood sugar is too high or low. You also may be tested to see if you have an infection. Computerized tomography (CT) scan. A CT scan uses a series of X-rays to create a detailed image of your brain. A CT scan can show bleeding in the brain, an ischemic stroke, a tumor or other conditions. You might have a dye injected into your bloodstream to view the blood vessels in the neck and brain in greater detail. This type of test is called a computerized tomography angiography. Magnetic resonance imaging (MRI). An MRI uses powerful radio waves and a magnetic field to create a detailed view of the brain. The test can detect brain tissue damaged by an ischemic stroke and brain hemorrhages. Sometimes a dye is injected into a blood vessel to view the arteries and veins and highlight blood flow. This test is called magnetic resonance angiography or magnetic resonance venography. Carotid ultrasound. In this test, sound waves create detailed images of the inside of the carotid arteries in the neck. A carotid ultrasound can show buildup of fatty deposits called plaques and blood flow in the carotid arteries. Cerebral angiogram. This test is less common, but it provides a detailed view of arteries in the brain and neck. A thin, flexible tube called a catheter is inserted through a small incision, usually in the groin. The tube is guided through the major arteries and into the carotid or vertebral artery in the neck. Then a dye is injected into the blood vessels to make the arteries visible under X-ray imaging. Echocardiogram. An echocardiogram uses sound waves to create detailed images of the heart. An echocardiogram can find a source of clots in the heart that may have traveled to the brain and caused a stroke. Treatment Emergency treatment depends on whether you're having an ischemic or hemorrhagic stroke. During an ischemic stroke, blood vessels in the brain are blocked or narrowed. During a hemorrhagic stroke, there's bleeding into the brain. Ischemic stroke To treat an ischemic stroke, blood flow must quickly be restored to the brain. This may be done with: Emergency IV medicine. An IV medicine that can break up a clot has to be given within 4.5 hours from when symptoms began. The sooner the medicine is given, the better. Quick treatment improves your chances of survival and may reduce complications. An IV injection of recombinant tissue plasminogen activator (TPA) is the gold standard treatment for ischemic stroke. The two types of TPA are alteplase (Activase) and tenecteplase (TNKase). An injection of TPA is usually given through a vein in the arm within the first three hours. Sometimes, TPA can be given up to 4.5 hours after stroke symptoms started. This medicine restores blood flow by dissolving the blood clot causing the stroke. By quickly removing the cause of the stroke, it may help people recover more fully from a stroke. Your healthcare professional considers certain risks, such as potential bleeding in the brain, to determine whether TPA is appropriate for you. Emergency endovascular procedures. Healthcare professionals sometimes treat ischemic strokes directly inside the blocked blood vessel. Endovascular therapy has been shown to improve outcomes and reduce long-term disability after ischemic stroke. These procedures must be performed as soon as possible: o Medicines delivered directly to the brain. During this procedure, a long, thin tube called a catheter is inserted through an artery in the groin. The catheter is moved through the arteries to the brain to deliver TPA directly where the stroke is happening. The time window for this treatment is somewhat longer than for injected TPA but is still limited. o Removing the clot with a stent retriever. A device attached to a catheter can directly remove the clot from the blocked blood vessel in the brain. This procedure is especially helpful for people with large clots that can't be completely dissolved with TPA. This procedure often is performed in combination with injected TPA. The time window when these procedures can be considered has been expanding due to newer imaging technology. Perfusion imaging tests done with CT or MRI help determine if that someone may benefit from endovascular therapy. Other procedures Your healthcare professional may recommend a procedure to open up an artery that is narrowed by plaque. This type of procedure is done to lower your risk of having another stroke or transient ischemic attack. Options vary, but include: Carotid endarterectomy. Carotid arteries are the blood vessels that run along each side of the neck, supplying the brain with blood. This surgery removes the plaque blocking a carotid artery and may reduce the risk of ischemic stroke. A carotid endarterectomy also involves risks, especially for people with heart disease or other medical conditions. Angioplasty and stents. In an angioplasty, a surgeon threads a catheter to the carotid arteries through an artery in the groin. A balloon is then inflated to expand the narrowed artery. Then a stent can be inserted to support the opened artery. Hemorrhagic stroke Emergency treatment of hemorrhagic stroke focuses on controlling the bleeding and reducing pressure in the brain caused by excess fluid. Emergency measures If you take blood-thinning medicines to prevent blood clots, you may be given treatment to counteract the blood thinners' effects. These treatments include medicines or a transfusion of blood products. Medicines also can lower the pressure in your brain, lower blood pressure, prevent spasms of the blood vessels and prevent seizures. Surgery If the area of bleeding is large, you may need surgery to remove the blood and relieve pressure on your brain. Surgery also may be used to repair blood vessel damage associated with hemorrhagic strokes. Your healthcare professional may recommend one of these procedures if an aneurysm, arteriovenous malformation (AVM) or other blood vessel condition caused the stroke. Surgical clipping. A surgeon places a tiny clamp at the base of an aneurysm to stop blood flow to it. An aneurysm is a bulge at a weak spot in a blood vessel. The clamp can keep the aneurysm from bursting. Or the clamp can keep an aneurysm that has recently burst from bleeding again. Coiling, also known as endovascular embolization. A catheter is inserted into an artery in the groin and guided to the brain. Using the catheter, a surgeon places tiny coils into the aneurysm to fill it. This blocks blood flow into the aneurysm and causes blood to clot. Surgical removal of a tangle of thin-walled blood vessels, known as an AVM. Surgeons may remove a smaller AVM if it's in an area of the brain that's easy to access. This removes the risk of rupture and lowers the risk of hemorrhagic stroke. However, it's not always possible to remove an AVM if it's deep within the brain or if it's large. It also may not be possible to remove if the procedure would impact brain function. Stereotactic radiosurgery. This procedure uses multiple beams of highly focused radiation to repair blood vessel malformations. Stereotactic radiosurgery is an advanced treatment that's not as invasive as other procedures. After emergency treatment, you're closely monitored for at least a day. After that, stroke care focuses on helping you recover as much function as possible and to return to independent living. The impact of the stroke depends on the area of the brain involved and the amount of tissue damaged. If the stroke affected the right side of the brain, movement and feeling on the left side of your body may be affected. If the stroke damaged the left side of the brain, movement and feeling on the right side of your body may be affected. Brain damage to the left side of the brain also may cause speech and language disorders. Most people who have had a stroke go to a rehabilitation program. Your healthcare professional can recommend the therapy program that is right for you. A program is recommended based on your age, overall health and degree of disability from the stroke. Your lifestyle, interests, priorities and whether you have help from family members or caregivers are considered. Rehabilitation may begin before you leave the hospital. After discharge, you might continue the program in a rehabilitation unit of the same hospital. Or you may go to another rehabilitation unit or to a skilled nursing facility as an outpatient. You also might have rehabilitation at home. Every person's stroke recovery is different. Depending on your condition, your treatment team may include: Doctor trained in brain conditions, known as a neurologist. Rehabilitation doctor, known as a physiatrist. Rehabilitation nurse. Dietitian. Physical therapist. Occupational therapist. Recreational therapist. Speech pathologist. Social worker or case manager. Psychologist or psychiatrist. Chaplain. Hemorrhagic stroke Hemorrhagic strokes are medical emergencies. They happen when a blood vessel in your brain breaks and bleeds. They require immediate treatment and can be fatal. Call 911 (or your local emergency services number) immediately if you think you’re experiencing symptoms. What is a hemorrhagic stroke? A hemorrhagic stroke is a life-threatening emergency that happens when a blood vessel in your brain breaks (ruptures) and bleeds. A “hemorrhage” is the medical term for bleeding inside your body. The bleeding disrupts normal circulation in your brain and prevents it from getting the blood and oxygen it needs to survive and function. The stroke also adds extra pressure inside your brain, which can damage or kill brain cells. Hemorrhagic (pronounced “hem-or-AJ-ICK”) strokes are particularly dangerous because they cause severe symptoms that get worse quickly. Without fast medical attention, these strokes often cause permanent brain damage and can be fatal. Symptoms and Causes What are hemorrhagic stroke symptoms? The symptoms of a hemorrhagic stroke can include one or more of the following:  Thunderclap headaches. Light sensitivity (photophobia). Dizziness or vertigo. Trouble understanding or speaking (aphasia). Slurred or garbled speaking (dysarthria). One-sided weakness or paralysis. Loss of senses like vision, hearing and touch. Neck stiffness. Nausea and vomiting. Seizures. Passing out or fainting. Coma. What are the warning signs of a hemorrhagic stroke? Hemorrhagic strokes can cause lots of different symptoms. To recognize the warning signs in yourself or a loved one, remember the acronym BE FAST: