Cardiovascular Conditions: Stroke Flashcards
Ischemic stroke caused by
thrombus (clot) in brain = non-caridoembolic (meaning not form in heart)
embolus (clot) forms in heart and travels up to brain = cardioembolic (common cause by AF)
87% of strokes
Hemorrhagic stroke is….
bleeding in brain
often by intracerebral hemorrhage or subarachnoid hemorrhage
13% of strokes
Transient ischemic attack
TIA = mini stroke
cause by temporary clot, symptoms resolve in minutes/few hours
often warning sign for acute ischemic stroke
Modifiable stroke risk factors
HTN = most important
Afib
Dyslipidemia
Diabetes
Physical inactivity
Smoking
Non-modifiable stroke risk factors
Prior stroke or TIA
Age > 80yrs old
Race (higher in AA)
Genetic disease (sickle cell)
F.A.S.T
Face dropping
Arm weakness
Speech difficulty
Time to call 911
Fibrinolytic drug FDA-approved to treat acute ischemic stroke?
Alteplase
Pts candidate for Alteplase if…
no bleeding seen on brain imaging and….
Stroke symptom onset < 4.5hrs per guidelines, <3 hrs per FDA
admin within 60min of hospital arrival
doesnt have contraindications for Alteplase
Alteplase Contraindications
Active internal bleeding
hx of recent stroke
Severe uncontrolled HTN ( > 185/110)
LMWH w/in 24hrs
DOAC w/in 48hrs
Warfarin + INr > 1.7
Blood glucose < 50
Aspirin for prevention of early recurrent stroke
81-325mg PO QD start within 48hrs after stroke onset
** not given within 24hrs of fibrinolytic therapy **
Prasugrel is contraindicated to anyone with history of
TIA or stroke
Should DAPT be used long term for secondary stroke prevention?
no
inc risk of hemorrhage
ER Dipyridamole/aspirin (Aggrenox) interchangeable with individual components?
No
Drug of choice in stroke/TIA if contraindicated or allergy to aspirin
Clopidogrel
Treating elevated intracranial pressure
Admin osmotic therapy with either hypertonic saline or mannitol
Mannitol info
inspect for crystals, if present then warm to redissolve
use filter for admin with conc > 20%
Subarachnoid hemorrhage (SAH) treatment
Nimodipine indicated only for SAH
Nimodipine Boxed warning
dont give IV*** important to note
