4 Stroke Flashcards
Medical risk factors 6
Hypertension AF Chol IHD Artery disease HRT? (Unsure but not recommended)
Non modifiable risk factors 5
Age Gender Family history Genetic conditions Afro-carabbean
Risk assessment tool for stroke is called…..
Chadsvasc
Risk assessment score for PE/DVT is called
Well’s
3 primary prevention of stroke treatments
Pharmacological
Lipid lowering drugs
Control of hypertension
Anticoagulation with other risk factors such as AF
Primary prevention treatments non-pharmacological
3
Diet, exercise, weight management
Somking
Reduce alcohol intake
Pateints with AF are …. times more likely to have a stroke
Five
Chadsvasc do you score someone for hypertension if it is controlled?
Yesssss
Modifiable risk factors 5
Smoking Alcohol Raised bmi Fatty diet Sedentary
Which to initiate first, OAC or anti hypertensives in AF
Anti hypertensives
What is first line treatment for AF
RATE CONTROL
Beta blocker
Or
Rate limiting CCB
What is second line for AF
Dual therapy:
Beta blocker plus digioxin
NOT BETA BLOCKER WITH CCB - heart block
(You could use CCB and digoxin in think…)
Third line for AF
RYHTHM CONTROL Elective DC conversion • Bisoprolol • Amiodarone • Flecainide or Sotolol • Dronedarone?
Amioderone shown to be benifical with warfarin but….
There is a interaction so INR is likely to be unstable while loading
What score is used to assess risk of stroke post Tia?
Abcd2
Post Tia would would also check
Heart rate (for AF) Glucose BP You might ct scan if you suspect another problem Smoking status
What to do if someone with AF presents with a stroke
You still need to rule out the bleed so withhold antiplatelets and anticoagulants
Therapies to prevent recurrent Stoke 6
Antiplatelets Blood pressure Statins Carteroid endarterectomy Anticoagulants (with AF) A smoking
What long term anti platelet is given for stroke
Clopidogrel
Post stroke what to change from aspirin to something else
After 14 day change to anticoagulants if with AF
(If without AF they should just have clopidogrel,
NO FUCKING ANTICOAGULANTS)
When after a stroke can you start messing with other patient meds
48 hours
Bonus stuff to assess in stroke?
SALT for swallow
Stroke in diabetic patient? 2
Remember to rule out hypo
Consider VRIII if they can’t eat
Why don’t we treat BP in the first two weeks after stroke?
We don’t want to reduce cerebral perfusion as this could result in brain damage.
If they are normally on anti hypertensives you could continue unless hypo.
