Cardio Stroke TIA ACS Flashcards
define stroke
sudden onset of rapidly developing focal or global neurological disturbance which lasts more than 24 hours or leads to death
define TIA
transient (less than 24 hours) neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without evidence of acute infarction
what are the three types of stroke?
ischaemic
haemorrhagic
silent
85% of strokes are
ischaemic
what occludes in an ischaemic injury
embolus afib or plaque rupture in coronary arteries
thrombus (atherosclerosis in brain)
the main cause of intracerebral haemorrhage is
hypertension
what can cause a stroke in trauma
carotid artery dissection
what causes a stroke in pregnancy or cancers
cerebral venous thrombosis
focal neurological deficits may include
Unilateral weakness or sensory loss. Dysphasia. Ataxia, vertigo, or incoordination. Syncope. Sudden transient loss of vision in one eye (amaurosis fugax). Homonymous hemianopia. Cranial nerve defects.
what else can cause a focal neurological deficit
hypoglycaemia drug toxicity vertigo syncope migraine with aura MS peripheral neuropathy infection encephalopathy tumour dementia spinal epidural haematoma
what are the symptoms of a posterior circulation stroke?
acute vestibular syndrome — acute, persistent, continuous vertigo or dizziness with nystagmus, nausea or vomiting, head motion intolerance, and new gait unsteadiness
Suspect ….. in anyone presenting with sudden severe headache and an altered neurological state until proven otherwise
subarachnoid haemorrhage
what is first line imaging
ct head to assess stroke type
how to manage ischaemic stroke acutely
alteplase (only if it can be given within 4.5 hours of symptom onset as long as haemorrhage has been excluded)
aspirin 300mg
how do you treat a history of dyspepsia with aspirin
add ppi
what is the long term management of ischaemic sttoke
75mg clopidogrel
statin 20-80mg
what If clopidogrel is contraindicated
dipyridamole with aspirin
if stroke with af
consider long term anticoags
how do you manange a haemorrhagic stroke?
surgery to remove haematoma and relieve icp
what should be done within 6 hours onset of haemorrhagic stroke
control hypertension
what is stable angina
occurs predictably with physical exertion or emotional stress, last for no more than 10 minutes (usually less) and is relieved within minutes of rest, as well as sublingual nitrates
what is unstable angina
new onset angina or abrupt deterioration in previously stable angina, often occurring at rest. Unstable angina usually requires immediate admission
in someone with stable angina what test should you do
ecg
when should a person call 999 with angina
chest pain - rest - gtn - take 2nd dose after 5 mins if pain not relieved - if not relieved after a further 5 mins - 999
