Stroke and heart attack: risk factors, symptoms and how to lower your risk
Published 1 September 2026 · Updated 21 October 2026 · Grand Medical, Riga
Myocardial infarction and stroke are among the most serious cardiovascular conditions. Sometimes they happen without clear warning signs, but the risk usually builds up gradually — shaped by blood pressure, cholesterol, smoking, diabetes, heart rhythm disorders and other factors.
It is worth being clear about one thing: a stroke and a heart attack are not the same, and not every stroke is caused by a plaque breaking loose. Many risk factors, however, are shared, and a timely consultation with a doctor and the right tests help detect changes that need attention.
How a stroke differs from a heart attack
A myocardial infarction happens when the blood supply to part of the heart muscle sharply worsens or stops. A common cause is a blood clot forming where the coronary arteries are affected by atherosclerosis.
A stroke is an acute disruption of the blood supply to the brain. It can be ischaemic, when a vessel becomes blocked, or haemorrhagic, when bleeding occurs. The causes vary: atherosclerosis, high blood pressure, heart rhythm disorders, vascular disease and other conditions.
This is why no single test can rule out a stroke or a heart attack for good. The sensible path is to assess your individual risk factors and choose the tests together with a doctor.
Which factors raise the risk of stroke and heart attack
Some factors cannot be changed: age, heredity, illnesses you have already had. Many risks, though, can be kept under control.
The most important ones include:
- high or unstable blood pressure;
- high cholesterol, LDL in particular;
- diabetes and disorders of carbohydrate metabolism;
- smoking;
- excess weight and low physical activity;
- irregular sleep and chronic stress;
- heavy alcohol use;
- heart rhythm disorders, including atrial fibrillation;
- a previous heart attack, stroke or transient ischaemic attack;
- early cardiovascular disease in the family.
The more of these factors come together in one person, the more important it is to discuss prevention with a doctor rather than go by how you feel.
Where to start with heart and vascular tests
The first step is not a bundle of tests ordered just in case, but a cardiologist consultation or an appointment with an internist. The doctor will go through your symptoms, family history, blood pressure readings and medicines, and choose the tests that are actually indicated.
Keeping track of blood pressure
High blood pressure often causes no symptoms, yet it gradually damages the blood vessels, heart, kidneys and brain. If your pressure rises only at times, changes through the day, or treatment has already been prescribed, 24-hour blood pressure monitoring (ABPM) can be useful.
ABPM shows what your blood pressure does in ordinary life — at work, at rest and during sleep. That gives the doctor a clearer picture of whether treatment needs adjusting.
ECG and Holter monitoring
An ECG shows your heart’s rhythm and conduction at the moment of the recording. It may be ordered for chest pain or discomfort, a sense of skipped beats, a racing heartbeat, shortness of breath, or as part of a routine check.
If symptoms come and go, your doctor may recommend Holter ECG monitoring. It records the heart over 24 hours or longer and helps pick up certain rhythm disturbances that a standard ECG does not always catch.
Echocardiography
Echocardiography — echo is an ultrasound scan of the heart. It shows the size of the heart chambers, how the valves work, how well the heart muscle contracts, and signs of strain on the heart, including from long-standing high blood pressure.
An echo does not replace assessment of the coronary arteries and does not determine the risk of a heart attack on its own. Combined with an examination, an ECG, blood pressure readings and lab tests, however, it gives the doctor important information about the state of your heart.
Doppler ultrasound of the head and neck vessels
Doppler ultrasound of the head and neck vessels shows the blood flow in the large vessels that supply the brain, and reveals atherosclerotic changes where they are present.
This test is particularly worth discussing with a doctor if you have high cholesterol, hypertension, diabetes, if you smoke, if you have had a vascular event before, if you get dizzy spells, or if there is a family history. The result should always be interpreted alongside your symptoms and your overall risk.
When CT angiography, MRI or coronary angiography are needed
CT angiography, MRI of the blood vessels, coronary angiography and other complex investigations can matter a great deal, but they are usually not the first step for everyone who has no symptoms.
They are ordered when there are specific reasons: symptoms, examination findings, an ECG, an echo, vascular ultrasound, or a need to clarify the diagnosis and the treatment plan. Arranging invasive or radiation-based tests on your own for peace of mind is not advisable — the right method is chosen by a specialist.
When it is worth booking an appointment soon
Plan a consultation if:
- your blood pressure rises regularly, or your treatment no longer works as it used to;
- you have noticed skipped beats, a racing heartbeat, shortness of breath, or less tolerance for exertion;
- you have high cholesterol or diabetes, or you smoke;
- close relatives had an early heart attack or stroke;
- you have previously had a heart attack, a stroke, a transient ischaemic attack or vascular surgery;
- you want to assess your cardiovascular risk and get a clear prevention plan.
If you have no symptoms but several risk factors, you can discuss a comprehensive health check-up with your doctor. The scope of testing should be sensible and tailored to you.
What actually helps lower the risk
Prevention is not a single ultrasound scan or blood test. It usually means keeping blood pressure, cholesterol and glucose under control, giving up smoking, staying regularly active within your means, eating enough vegetables and fibre, bringing your weight into a healthy range, and sticking to the treatment you have been prescribed.
Do not stop taking blood pressure, cholesterol or blood-thinning medicines on your own. If side effects or doubts come up, talk them through with your doctor: the regimen can often be adjusted safely.
Frequently asked questions
Can a vascular ultrasound rule out a stroke completely?
No. A Doppler scan shows the condition of the vessels examined and the blood flow through them, but it does not rule out every cause of stroke. The result is assessed together with your risk factors and your doctor’s advice.
Will an echocardiogram show my risk of a heart attack?
An echo assesses the structure and function of the heart. Blood pressure, cholesterol, symptoms, the ECG, lifestyle and other data all matter for assessing risk.
Do I need 24-hour blood pressure monitoring if my pressure only rises occasionally?
That is worth discussing with your doctor. ABPM is especially useful when readings differ at home and at the clinic, when pressure is unstable, or when the effect of treatment needs to be assessed across a full day.
Can a standard ECG look normal if I get occasional palpitations?
Yes. If symptoms are not constant, your doctor may recommend Holter monitoring.
When should I call an ambulance rather than book an appointment?
If speech suddenly becomes difficult, if there is weakness or numbness on one side of the body, chest pain or pressure, severe shortness of breath, fainting, or a sudden unusually severe headache — call 113 or 112 straight away.
Would you like to assess your heart and blood vessels?
Start with a doctor’s consultation — they will help you choose the tests that you actually need.
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