Subject Expert. Michelle Whaley MSN, CNS, CCNS, ANVP-BC Swedish Medical Center Englewood, CO

Transcription

1 Stroke 101

2 Subject Expert Michelle Whaley MSN, CNS, CCNS, ANVP-BC Swedish Medical Center Englewood, CO 2

3 Objectives Types of strokes Stroke warning signs Stroke risk factors Medical test performed following a stroke Emergency treatments available for stroke patients Primary and secondary stroke prevention 3

4 What Is a Stroke? A stroke is caused by the interruption of normal blood flow to arteries in the brain Some strokes are small, others are large Strokes can be ischemic or hemorrhagic 4

5 Stroke Types 87% of strokes are ischemic They are most often caused by a blockage or a blood clot 13% of strokes are hemorrhagic They are most often caused by the rupture of a blood vessel MRI image with multiple small, ischemic strokes Courtesy of Swedish Medical Center 5

6 Ischemic Stroke Hemorrhagic Stroke 6

7 Stroke Types Ischemic (blood clot) stroke Embolic - Blood clot forms and travels to the brain - Often originates in the heart Thrombotic - Cholesterol plaque breaks off and causes blockage - Artery becomes blocked at the plaque 7

8 How Common Is Stroke? Stroke is the 5th leading cause of death Nearly 800,00 strokes occur each year 1 every 40 seconds Over 140,000 deaths from stroke each year 1 out of every 20 adult deaths in the U.S. Stroke is a leading cause of serious, long-term adult disability in the U.S. Prevention is the best treatment! 8

9 Stroke Warning Signs Sudden onset, with no known cause Weakness Numbness Difficulty speaking or understanding words Vision loss Trouble walking, dizziness Severe headache 9

10 Why Did I Have a Stroke? 10

11 Stroke Risk Factors Modifiable High blood pressure Heart disease Atrial fibrillation Smoking High cholesterol Diabetes Carotid artery disease Heavy alcohol use Drug abuse Age Non-modifiable Gender Race History of TIAs or prior stroke Family history 11

12 Why Did I Have a Stroke? Other causes Cryptogenic Unknown Small vessel Disease Tiny arteries become narrow or get blocked by cholesterol 12

13 Medical Tests Following Stroke MRI of the brain - Determines location and size of stroke Ultrasound of the carotid arteries - Looks for areas of narrowing or plaque Ultrasound of the heart - Examines the function of the heart Heart monitor - Watches for abnormal heart beats Blood tests - Determines cholesterol and blood sugar levels 13

14 What emergency treatments are available? 14

15 Acute Ischemic Stroke Treatment Clot busting medications IV Alteplase (tpa) Can be given up to 4.5 hours from the time a person was last seen normal Not every person is a candidate for this treatment Only people who get to the hospital right away are eligible for this treatment. Don t delay! 15

16 Acute Ischemic Stroke Treatment Surgical treatments Clot removal from the artery using catheter Can only be used in the larger arteries of the brain Time is important. Don t delay! 16

17 Acute Hemorrhagic Stroke Treatment Treatments depend on type of hemorrhage High blood pressure (most common cause) Lower blood pressure with medication Aneurysm (least common cause) Surgical treatment to prevent aneurysm from re-bleeding 17

18 Stroke Prevention is the Best Treatment! Primary Prevent a first-ever stroke Secondary Prevent another stroke from happening again 18

19 Primary Prevention If you smoke, STOP! Control blood pressure Keep LDL cholesterol < 70 mg/dl Control blood sugar Atrial fibrillation (irregular heartbeat) Discuss the use of blood thinners with your doctor or nurse Eat a healthy diet Increase physical activity 19

20 Primary Prevention Smoking New treatments are available Talk to your doctor Multiple attempts might be necessary Don t get discouraged if you fail, keep trying 20

21 Hypertension Primary Prevention Goal BP < 130/90 mm Hg Small changes result in a greater decrease in stroke risk Lower is better! Diabetes Normal finger stick blood sugars mg/dl Hemoglobin A1c blood test < 7.0% Cholesterol LDL (bad cholesterol) < 70 mg/dl Control with healthy eating, physical activity, and/or medication 21

22 Atrial Fibrillation (AFib) Irregular heart rhythm Predisposes to stroke During heart pauses à blood pools à forms a blood clot à travels to the brain à STROKE Stroke prevention Blood thinning with anticoagulants Warfarin (Coumadin) Keep INR blood levels between 2-3 New Medication (Pradaxa, Xarelto, Eliquis ) More expensive than Warfarin, but no blood testing needed 22

23 Carotid Artery Disease Narrowing of the carotid artery >70% blockage meets criteria for surgery Carotid stent or open surgery Even if no history of stroke 23

24 Primary Prevention Sickle Cell Disease (SCD) Predisposes patients to stroke (mostly children of African-American descent) Transcranial Doppler (TCD) Ultrasound helps select patients who need blood transfusions Transfusions significantly reduce the chance of having a first-time stroke by 91% 24

25 Secondary Prevention Antiplatelet medications Aspirin Clopidogrel Extended-release dipyridamole/aspirin Blood thinners Warfarin Pradaxa, Xarelto, Eliquis More aggressive lowering of cholesterol Surgery to remove carotid plaque or use of stent 25

26 Secondary Prevention High Blood Pressure (Hypertension) à Small reductions = BIG impact on stroke 26

27 Stroke Risk Reduction 0.2 Proportion with 2 nd Stroke Sugar pill BP Meds 28% Reduction

28 High Blood Pressure You may need more than 1 medication Goal < 130/90 mm Hg Get your own blood pressure cuff Take your blood pressure twice a day Record your reading and share with your doctor or nurse 28

29 Diabetes Goal is to get sugars back to a normal range Hemoglobin A1c test Average of blood sugars over 3 months Goal for stroke patients <7.0% May need multiple medications including insulin 29

30 High Cholesterol Two important types of cholesterol LDL ( bad ) HDL ( good ) Statin medications: goal is primarily to get the LDL lower Statins: depends on whether there is a history of heart disease If history of heart disease and stroke Start if the LDL is >100 mg/dl 30

31 Healthier Eating Modify and improve what you eat Monitor portion control Increase fruits, vegetables and whole grains Bake, roast or grill foods Drink water 31

32 Be Active It all adds up do what you can do! Improvement comes from you! Patient has to be motivated to move or do exercises. Do it safely Work up to 30 minutes/day for exercise Can include walking, chair exercises, riding a bike, and gardening 32

33 A Dreaded Second Stroke Within 5 years of your first stroke Your risk for another stroke can increase more than 40% 24% of women and 42% of men will experience a second (recurrent) stroke Recurrent strokes Higher rate of death and disability because parts of the brain already injured by the original stroke may not be as resilient 33

34 But Doc.I Feel Fine Goal is prevention You won t feel the medications working Follow your doctor s instructions and take your medication 34

35 Questions? 35

36 THANK YOU! Learn more at stroke.org STROKES ( ) 2017 National Stroke Association