Stroke Guidelines and Awareness

Imagine a serious disease that:

• Has impacted an estimated 7 million people in the United States over the age of 20, according to the American Heart Association (AHA);
• Is the fifth leading cause of death in the country and the third leading cause of death for women, according to the U.S. Centers for Disease Control and Prevention; and
• Is impacting young adults at rates that have nearly doubled in a decade, according to the AHA. Yet this dangerous malady, which has few warning signs, is preventable in most instances by adopting a healthier lifestyle.

This is not the plot of a new science fiction thriller. The mystery disease is stroke, which occurs when blood flow to the brain is blocked, whether due to a blood clot in a blood vessel in the brain (called an ischemic stroke) or by bleeding in or around the brain (a hemorrhagic stroke).

The best way to avoid becoming one of the 140,000 Americans who die each year due to a stroke is by knowing the stroke guidelines, including the risk factors and symptoms of an attack. For people who have had a stroke, there is a brief three-hour window to receive medical care that can make a significant difference in recovery once the stroke has started.

Approximately 87% of all strokes are ischemic. For this type of stroke, there is an effective medication called alteplase (intravenous r-tPA). If given in time and if the patient has no contraindications, r-tPA can dissolve the clot and help restore blood flow. However, the patient must receive this treatment within three hours of the stroke’s onset. (Note that researchers have developed a new technique that uses perfusion imaging to extend this “window” of treatment to nine hours, as reported on MedScape.)

Think ‘FAST’

Recognizing the signs of stroke is essential to getting help quickly. To help understand these symptoms remember, FAST.

• Face – Does one side of your face droop when you smile?
• Arms – Raise both arms. Does one drift down?
• Speech – Say a simple sentence. Is speech slurred?
• Time – If any of these signs are present, call 911 immediately.

A stroke is a medical emergency. As healthcare professionals, it’s important to recognize these signs so that you can provide immediate help to anyone you suspect may have had a stroke.

Know the Stroke Guidelines’ Risk Factors

While many risk factors for stroke are beyond our control such as age, ethnicity, and gender. There are many lifestyle factors in the stroke guidelines that can be modified to reduce the risk.

The most common risk factors for stroke include:

• Age – 55 or older
• Ethnicity – African American
• Gender – female
• Tobacco – smoking or exposure to second-hand smoke
• Obesity – overweight or obese
• Poor physical fitness – limited physical activity
• Alcohol – too much alcohol (or illicit drugs)
• High blood pressure – greatest single risk factor
• Atrial fibrillation – specific type of abnormal heart beat
• Sleep apnea – untreated
• Stroke – history of previous stroke

It’s important for individuals with one or more of these risk factors to discuss them with a healthcare professional. Lifestyle changes such as keeping fit, losing weight, limiting alcohol consumption, and stopping smoking can greatly reduce the risk of having a stroke.

Types of Stroke

There are three main types of stroke: ischemic, hemorrhagic, and transient ischemic, which is also called a “ministroke.” All three result in damage to the vessels of the brain and may have similar symptoms; however, they have very different causes and require very different treatment.

• Ischemic — This type of stroke is caused when a blood clot breaks free and flows into a blood vessel of the brain. By far the most common form, ischemic strokes account for about 87% of all such attacks. The treatment is removal of the blood clot to restore blood flow and can be achieved with medications such as alteplase (IV r-tPA), surgery, or a combination of the two. The sooner treatment is started, the less potential damage occurs to the brain.
• Hemorrhagic — This type of stroke occurs when a weakened section of a blood vessel bursts, allowing blood to flow freely outside the vessel and into the surrounding brain tissue. The goal of treatment for hemorrhagic stroke is to stop the bleeding quickly. Treatment options include medication, surgery, and life support.
• Transient ischemic attack (TIA) — This type of stroke is caused when the flow of blood to an area of the brain is blocked for only a short time, typically for less than five minutes. The danger with TIAs is that one-third of TIA patients who don’t seek treatment will experience a major stroke within the next year, according to the CDC. Because the symptoms of an ischemic stroke and TIA are identical, it is imperative for anyone experiencing stroke symptoms to seek medical care immediately, even if the symptoms abate. Treatment for TIAs includes administering anti-platelet drugs and anticoagulants to prevent clots from forming.

Healthcare professionals play an important role in helping to identify and provide care for individuals affected by stroke. Since a stroke can occur at any time, they may be the first to recognize the symptoms.

Stroke Care Team

Many medical facilities have created stroke care teams. These teams are made up of healthcare professionals who ensure a rapid response and continuity of care for stroke patients. A skilled healthcare administrator is essential in order for these teams to function cohesively and efficiently.

Imaging technologists are another key member of the stroke care team. There are many imaging tests that may be used in the diagnosis and assessment of stroke, such as computed tomography (CT) scan, magnetic resonance imaging (MRI), carotid ultrasound, cerebral angiogram, and echocardiogram. These imaging tests are crucial to formulating an accurate diagnosis and proper treatment.

Original article by Advent Health University.