Randy Travis: How strokes can be side effect of heart problems

Randy Travis performs during the 4th Annual ACM Honors at the Ryman Auditorium on Sept. 20, 2010, in Nashville, Tenn.
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Randy Travis is recovering from surgery after he suffered a stroke and needed a procedure to relieve pressure on his brain.

The Baylor Health Care System said that the country musician remains in critical condition and is still in congestive heart failure.

Travis' hospitalization began when he was admitted to the emergency room of Baylor Medical Center in McKinney, Texas with presumptive cardiomyopathy and congestive heart failure on Sunday. He was later diagnosed with viral cardiomyopathy. Due to heart failure, the singer had an IMPELLA peripheral left ventricular assist device (LVAD) implanted in order to help his heart pump. The procedure was completed without heart surgery, instead doctors inserted the device using a catheter.

He remains at The Heart Hospital Baylor Plano in Plano, Texas.

Cardiomyopathy is a disease of the heart muscle that can cause the heart to become enlarged, thick or rigid, according to the National Heart, Lung and Blood Institute. The weakened heart cannot pump as much blood, which leads to heart failure or irregular heartbeats called an arrhythmia.

Dr. William Gray, director of cardiovascular services at Baylor Medical Center, said Travis was completely fine until three weeks ago, when he had developed a viral upper respiratory illness.

Viruses that can lead to respiratory infections could also infect the heart, Dr. Randall Starling, a heart failure specialist at the cardiovascular medicine department of the Cleveland Clinic, previously told

Travis' doctors said the stroke was a complication due to his current heart problems.

The National Stroke Association said that strokes are the fourth leading cause of death in America, killing over 133,000 people annually There are an estimated 7 million stroke survivors over the age of 20 in the U.S. alone. In 80 to 85 percent of the cases, a clot causes the blockage. The remaining cases are caused by bleeding in the brain.

Strokes, sometimes called "brain attacks," are particularly dangerous because they stop blood flow to the brain, potentially causing significant damage. Dr. Richard Libman, vice chair of neurology at Long Island Jewish Medical Center in New Hyde Park, N.Y., said to that every minute without blood, 1.9 million brain cells die.

"We lose brain cells as we age... (but) one hour of a blocked blood vessel to the brain is about the same as 10 years of normal aging," he explained.

Libman, who is not involved in Travis' care, said that anything that interferes with the normal pumping of the heart can lead to blood clots forming. The clots then leave the heart and travel up to the brain, blocking off blood supply and causing a stroke. While there is a possibility that Travis could have had bleeding in the brain, Libman suspects that a clot was the most likely cause.

Stroke symptoms include numbness or weakness of the face, arm or leg; sudden confusion, trouble speaking or understanding speech, trouble seeing in one or both eyes, difficulty walking, dizziness, loss of balance or coordination and a sudden, severe headache with no known cause. If a patient recognizes he or she is having a stroke and gets immediate care, doctors can administer a clot-busting medication called TPA. TPA is most effective up to three hours from the onset of symptoms, and patients can get some benefits taking the drug for up to 4.5 hours. The drug is less effective after that time frame and can become dangerous for the patient.

For patients with heart-pumping problems like Travis, strokes are a common risk, said Libman. He explained they are typically prescribed blood-thinning medications like aspirin or Warfarin in order to prevent clots.

However, if they do experience a stroke, patients may experience swelling in the brain. This could cause more damage than the stroke itself.

"Just as it would happen as you traumatize your elbow, when you have a major blockage to the blood vessel to the brain within a day or two you can get major swelling of the brain," he explained. "The swelling can cause so much pressure inside the head the brain itself becomes compressed or squashed."

In order to get rid of the mounting pressure, doctors sometimes remove a piece of the skull to give the brain room to swell.

"While it sounds kind of unusual, it just allows the brain to swell a couple days and gives it some space," Libman said. "Many people make a remarkably good recovery after this kind of procedure."