Kris Letang had a stroke

[chrisehyoung 14]

Wow. Just read that Kris Letang had a stroke last week and will be out indefinitely.

[Tyler Roy 86]

6 weeks or so according to something I just read. Just crazy...

[nittanypucker 1]

Really hope he's going to be ok. I haven't heard any details.

[bunnyman666 445]

Strokes are scary. Let's all hope he has all of his previous abilities.

[Tyler Roy 86]

Shouldn't be career ending and doctors believe his situation can be solved with blood thinners and recovery time should be at least 6 weeks. Terrible thing to happen to somebody.

[icewalker_bg 126]

My guess would be that stroke is hockey related? From all the hits? <br /><br />He seems too young to have a stroke.

[Tyler Roy 86]

Perfectly "healthy" people have strange things happen all the time. Could be completely unrelated to hockey.

[minnsy 15]

Doctors also said that he has a heart condition (a hole in his heart) that may have lead to the stroke. According to them, everyone is born with this hole, but for most of us it closes up shortly after birth. His did not.

[Dr. Funk 6]

While I don't have any firsthand knowledge of Kris Letang's situation, I'm an emergency physician who deals in stroke care. This is a really complex situation, but I'll try to break it down a bit. This is obviously not medical advice in any way - just an attempt to explain the generalities of stroke. Again, I don't have any current connection with the Penguins or their medical staff.

Icewalker, you're definitely correct in thinking that he's really young for a "typical" stroke patient. However, it's pretty unlikely that his stroke has anything to do with hockey. First off, there are "cerebrovascular accidents" (CVAs, or "full strokes") and "transient ischemic attacks" (TIAs, or "ministrokes"). The big differences between these two conditions are:

1. CVAs are associated with permanent deficits such as paralysis, speech difficulty, or whatever else the injured brain tissue is responsible for doing. The problems with TIAs go away completely, typically within a short time.

2. CVAs are almost always associated with abnormal imaging studies, like a brain CT scan or MRI. TIAs usually have normal imaging studies.

There are two basic types of strokes: Ischemic (meaning that the blood flow to an area of the brain is cut off, typically by a blood clot, and results in impaired function of that brain region) and hemorrhagic (actual bleeding in brain tissue, typically caused by high-energy trauma, high blood pressure, and other things). Both types can be catastrophic or quite minimal. From the Pens' description of things - specifically, the fact they they mentioned a "hole in his heart" - it sounds like he's suffered an ischemic stroke.

Ischemic strokes can be caused by a variety of things, one of which involves a blood clot passing through something called a patent foramen ovale and subsequently becoming lodged in a blood vessel supplying part of the brain. A PFO results from a congenital problem where a normal hole in someone's heart doesn't close properly during childhood. Up to 40% of people who are diagnosed with strokes and don't have other risk factors (like high blood pressure or bad cholesterol) are found to have PFOs.

There are a bunch of other things that can cause strokes in young people, from really bad high blood pressure, to sickle cell disease/other problems that make someone's blood "too thick," to conditions that lead to excess blood clotting (ironically, which is what's keeping Tomas Vokoun out). However, the Penguins have said that Kris has a "hole in his heart," which makes me think that a PFO is involved in his case. If I recall correctly, Teddy Bruschi had a similar condition.

With respect to his career, all we can do is hope for the best. He's been spotted at games and has been cleared to vacation with his family during the Olympic break, which makes me think that he's doing pretty well. He may have even had a TIA rather than a full CVA, which would be great news. The prognosis for stroke is complicated, but is largely tied to the area of the brain that's been affected. His symptoms reportedly began with nausea and other nonspecific stuff (which makes the diagnosis really hard, and probably explains all of the uncertainty surrounding his "illness" over the past week or so, and he's been skating/working out. Hopefully, they means that he'll make a full recovery. Treatment also depends upon a lot of things; however, blood thinners like warfarin (Coumadin) are typically prescribed for at least six months.

Like I said, just my two cents'. Not firsthand knowledge in any way, and certainly not medical advice. Hope that this helps people to understand the basics a bit.

[psh 25]

Many thanks, Dr. Funk.

When a hole in the heart, like Letang's, is discovered, does that usually indicate a surgery to repair it? If the hole is not repaired, does Letang remain at heightened risk for further clotting and possible stroke? And, if Letang is placed on blood thinners for the long term, can that affect his athletic performance? For instance, one would think that thinner blood might raise blood pressure and/or influence the oxygenation process. A rank medical amateur, like myself, would assume that thinner blood has less hemoglobin by volume and would, thus, carry less oxygen.

[camhockey16 5]

while i'm sure it would have been better for them to have known about the hole in his heart a while ago - is it fair to say that he is pretty lucky nothing worse happened? i know letang is supposedly a workout freak - im kind of surprised this is the first time anything has ever happened.

i mean there are plenty of other players that have collapsed and died before they realized they had a heart condition..

i bet lemieux will probably be talking to him as well since lemieux had to retire from his heart condition - atrial fibrillation

[chrisehyoung 14]

My best friend growing up was 26 when he died from a heart condition. The first symptom was when his heart went haywire at work. He died minutes later. Letang was lucky. Here's hoping he leads a long, healthy life.

[Dr. Funk 6]

PSH,

Treatment for patients with PFO depends upon a variety of things. Yes, you can perform open-heart surgery to close the hole (which is actually better thought of as a one-way valve with a flap, which opens under circumstances that increase pressure in the cheer, like sneezing or coughing). Physicians can also perform minimally-invasive procedures to close the defect. Imagine something very similar to a cardiac catheterization to insert a stent for a blockage, if you/someone in you family has gone through that.

Yes, those with a PFO are likely at slightly increased risk for recurrent strokes (or blood clots that travel other places - the big one is pulmonary embolus, a blood clot that migrates to the lungs and can be very serious). In fact, a second stroke is a definite indication to perform a procedure to close the defer in "normal" people. In most people, doctors would try medications first, and if the patient strokes again despite these medications, a procedure would be performed at that point.

With respect to Letang however, the decision regarding medications versus surgery is a little more complicated. You probably don't want a collision-sport athlete on medications like warfarin (which predispose them to bleeding). That's why Vokoun isn't playing right now; he was started on medications to dissolve his blood clots, and is now being weaned off them while he's returning to the ice. Warfarin and other anticoagulant medications don't really influence oxygenation, and don't themselves have any real effect on athletic performance. However, they would definitely predispose someone to experience bleeding into soft tissues, joints, and other areas (the brain, in the worst-case scenario) with and without physical contact. This wouldn't be a big deal if he was a pro golfer, but it's obviously a big issue playing a collision sport.

The term "bloodthinners" is actually sort of a misnomer; most of these medications don't actually "thin" the blood. Rather, they work at a molecular level to stop coagulation. Physicians - and I'm just as guilty as my colleagues - use that term to make things a little easier to understand.

Cam, while it is true that Lemieux suffered from atrial fibrillation (an abnormal rhythm of the heart, which can also predispose someone to have blood clots), that condition is often not associated with any structural heart abnormalities. Think of "a-fib" as a problem with the heart's wiring, while a PFO is more of a plumbing issue allowing fluid and debris to go somewhere that they're not supposed to. In many cases, this isn't associated with any structural issues; however, sometimes it is. Not sure about 66's case. Mario did undergo a procedure to eliminate the circuitry that was causing his a-fib, which would be very similar to one of the procedures that Kris could undergo (a large IV catheter would be inserted into one of his blood vessels, run through his body to his heart, and the procedure could be performed at the heart without any big incisions). As far as I know, Mario is no longer on anticoagulants - a big benefit of having the procedure rather than taking these sort of medications.

Chris, drag about your bud. Condolences.

And Cam, you're absolutely right that this, while serious, isn't nearly as bad as other stuff that could've happened. He could've had a large, catastrophic stroke that rendered him unable to walk/speak/eat. He could've also suffered a pulmonary embolus - a blood clot that travels through this small abnormality in his heart, and lodges in the blood vessels supplying his lungs,

- which can cause sudden death, as well as a variety of long-term lung problems.

One thing that I should add is that additional diagnostics will be needed to determine if Letang had a blood clot (which travelled through his body, through his heart defect, and lodged in his brain's blood vessels) and why. There are a ton of genetic problems that can predispose someone to have blood clots, but a lot of time it's just bad luck. Sometimes, long-term immobilization of a limb (like a cast for a broken leg, or a transcontinental flight when someone doesn't move an extremity for a long time) or relatively minor trauma can cause "deep venous thrombosis" (DVT).

(Edited for my fat fingers typing on my iPad).

[psh 25]

Thanks for taking so much time to reply in detail, Dr. Funk.

[mojo122 529]

It's nice having a doctor in the house. And an emergency medicine physician!

[Dr. Funk 6]

Thanks for the dap, team. My pleasure to help out in whatever small way that I can.

[zyzzbraaa 0]

what a shame. Hope it will not affect him too much.