Download Stroke 101 - National Stroke Association

Stroke 101
Goals of Presentation
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What is a stroke?
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Types of stroke
Warning signs of stroke
Why did I have a stroke?
Are there treatments for stroke?
How can I prevent a stroke?
What Is a Stroke?
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Interruption of normal blood flow to the brain
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Ischemic
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Blockage or clot
80% of strokes
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Hemorrhagic
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Rupture of blood vessel
20% of strokes
Stroke Types
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Ischemic (blood clot) stroke
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Embolic
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Neck blockage (carotid artery)
Heart (atrial fibrillation)
Thrombotic
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Cholesterol plaque ruptures
Artery becomes blocked at the plaque
Ischemic Stroke
Hemorrhagic Stroke
Carotid Ultrasound
How Common Is Stroke?
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4th leading cause of death in U.S.
795,000 strokes/year
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130,000 deaths from stroke/year
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1 every 40 seconds
1 out of every 17 deaths in the USA
Stroke is a leading cause of serious, longterm disability in the U.S.
Data from NINDS, CDC, American Heart Association
Stroke Warning Signs
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Sudden onset of:
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Weakness or numbness of the face, arm or leg,
especially on one side of the body
Confusion, trouble speaking or understanding
Trouble seeing in one or both eyes
Trouble walking, dizziness, loss of balance or
coordination
Severe headache with no known cause
Stroke Warning Signs
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FAST
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Face
Arm
Speech
Time
Why Did I Have a Stroke?
Stroke Risk Factors
Modifiable
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High blood pressure
Heart disease
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Atrial fibrillation
Smoking
High cholesterol
Diabetes
Carotid atherosclerosis
Heavy alcohol
Drug abuse
Non-modifiable
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Age
Sex
Race
History of prior stroke
Family history
Why Did I Have a Stroke?
Hemorrhagic stroke
12%
Other
5%
Cryptogenic
30%
Heart
20%
Ischemic stroke
80%
Atherosclerosis
20%
Small vessel
disease
“lacunae”
25%
Are There Any Stroke Treatments?
Early Treatment Better
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IV-tPA
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Clot-buster that re-opens arteries
< 3 hours* from symptom onset
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* May be extending to 4.5 hours soon
Earlier the better!
Dead brain
Dying brain
Other Treatments
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None approved for stroke treatment yet…
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Clot retrieval devices
Other Treatments
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None approved for stroke treatment yet…
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Clot retrieval devices
Clot suctioning devices
Newer clot-busting drugs
Combination treatments
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clot-buster + blood thinners
clot-buster + ultrasound / microbubbles
clot-buster + cooling body temperature
Stroke Prevention
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Primary
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Prevent a first-ever stroke
Secondary (Recurrent)
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Prevent a second stroke [after the 1st]
Primary Prevention
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Stop smoking
Keep blood pressure, cholesterol and
diabetes under control
Irregular heartbeat, atrial fibrillation –
work with your doctor to control
Eat a healthy diet
Increase physical activity
Primary Prevention
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Smoking
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New treatments are available
Talk to your doctor
Multiple attempts might be necessary
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Don’t get discouraged if you failed once (or twice)
Primary Prevention
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Hypertension
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Goal BP <140/90
Diabetes
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Normal finger stick blood sugars
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Hemoglobin A1c blood test
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80-120
< 7.0
Cholesterol
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LDL (bad cholesterol) < 100
Always try diet and exercise first
Primary Prevention
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Hypertension
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Goal BP <140/90
Small changes in your BP can result in large
decrease in your stroke risk (as little as 2-3
points)
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Example: BP 142/90  139/84
Atrial Fibrillation (Afib)
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Irregular heart rhythm
Predisposes to stroke
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During heart pauses  blood pools  forms a
blood clot  travels to the brain  STROKE
Stroke prevention
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Anticoagulation
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Usually with warfarin (Coumadin)
• Get your blood levels: INR: goal 2-3
New treatments are on the way….
Primary Prevention
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Carotid stenosis
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>60% blockage meets
criteria for surgery
Even if no history of
stroke
Primary Prevention
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Sickle Cell Disease (SCD)
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Predisposes patients (mostly children of AfricanAmerican decent) to stroke
Ultrasounds (Transcranial Doppler- TCD) help
select patients who need blood transfusions
Transfusions significantly reduce the chance of
having a first-ever stroke
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By 91%!
Secondary Prevention
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Blood thinners
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Aspirin
Clopidogrel
Extended-release dipyridamole/aspirin
Warfarin
More aggressive lowering of cholesterol
Surgery for carotid plaque
Secondary Prevention
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High Blood Pressure (Hypertension)
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Small reductions = BIG impact on stroke
Blood pressure (mm Hg)
160
Systolic
140
Average BP difference:
9 /4 mm Hg
120
BP Meds
Sugar pill
100
80
Diastolic
60
1
3
6
9
12
18
24
Months of follow-up
30
36
42
48
Stroke Risk Reduction
Proportion with 2nd Stroke
0.2
28%
reduction
0.15
Sugar pill
BP Meds
0.10
0.05
0.0
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1
2
3
4
High Blood Pressure
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You may need 3 or more
medications
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Goal 120/80
Get your own blood pressure
cuff
Take it twice a day
Write the #s down and show
your doctor
Diabetes
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Goal is to get sugars back to a normal
range
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Hemoglobin A1c
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Average of blood sugars over 3 months
Goal for stroke patients <7.0
May need multiple medications including insulin
High Cholesterol
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2 important forms 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 (& stroke)
• Start if the LDL is >100
• Target of <70 if multiple risk factors
Data from: Stroke 2008;39:1647-1652.
High Cholesterol
QUESTION:
But I’ve only had a stroke and I don’t have a
history or heart disease. Should I be on a statin
medication?
ANSWER:
Yes, if your LDL is >100.
Data from: Stroke 2008;39:1647-1652.
Healthier Eating
Modify and improve what you eat
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Monitor portion control
Increase fruits, vegetables and whole grains
Bake, roast or grill foods
Drink water
Exercise
It all adds up – do what you can do!
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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 exercise
A Dreaded 2nd Stroke
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Within 5 years of your first stroke
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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
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Higher rate of death and disability because parts
of the brain already injured by the original stroke
may not be as resilient
“But Doc….I Feel Fine”
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Goal is prevention
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You won’t feel the medicines working
Follow your doctor’s directions and take your
medicine