Hypertension and stroke

Question 1

What can persistently high blood pressure cause?

Answer 1

– Stroke (hypertension is the most modifiable risk for stroke)
– Heart disease – Renal disease – Visual failure
– …death
There are often no signs until something drastic happens

Question 2

How can you test blood pressure?

Answer 2

• Sphygmomanometer • Initial high readings • Retest
• Refer to GP
• Also look for secondary effects – ECG
– Renal function – Eyes – Ix for secondary causes

Question 3

How should high bp be managed?

Answer 3

Lifestyle changes only start prescribing medication if there’s persistent bp of 160/90mmHG .
Drugs:
beta blockers, calcium channel blockers, statins, ACE inhibitors

Question 4

What’s the burden of stroke?

Answer 4

It’s the leading cause in hospital mortality
Second leading cause of death
Major cause of acquired disability

Question 5

Some pointers to help you know it’s a stroke?

Answer 5

• Acute and sudden onset of symptoms
• Focal neurological deficit not global
• Pattern of symptoms and signs attributable to one part of the brain and a particular vascular supply

Question 6

What’s a TIA?

Answer 6

• Differs from stroke only in duration.
• Brief episode of neurological dysfunction caused by focal brain or retinal ischaemia; symptoms lasting typically less than an hour, without evidence of infarction.
– Many patients with TIA’s lasting more than two hours will have infarction on MRI scan
• Requires urgent assessment as many high risk for full CVE

Question 7

What’s the ABCD2 score?

Answer 7

Stratifies the risk of stroke • Based on simple clinical observations • may be appropriate to admit and assess.
It can predict whether a stroke will take place in the next two days.

Question 8

What are the different types of stroke?

Answer 8

TACI-embolism-poor outcome
PACI-embolism-good outcome
LACI-small vessel disease-fair outcome
POCI-variable mechanism and variable outcome

Question 9

What are the modifiable risk factors for ischaemic stroke?

Answer 9

• Hypertension
• Diabetes
• Smoking
• Hyperlipidemia
• Carotid stenosis
• Atrial fibrillation

Question 10

Management of stroke?

Answer 10

FAST:
F-facial palsy, which side?
A-arm weakness, which side?
S-speech
T-time
• General medical care on a STROKE UNIT —NNT 12
• If Infarct Aspirin 300mgs OD. (Add Dipyridamole Retard within 2 weeks)
• Swallow assessment • Pressure sore prevention/TED stockings • Hydration and nutrition • Antipyretic • Active glucose monitoring and lowering if raised
• Physiological monitoring

Question 11

What is a stroke unit?

Answer 11

• Care co-ordinated by a multidisciplinary team
• Team meets to discuss patients at least weekly
• Nurses have expertise in rehabilitation
• Team consists of professionals interested in and specialising in stroke
• Regular in-service training for staff is provided
• Involvement of carers in patient care

Question 12

What’s secondary prevention of a stroke?

Answer 12

• Thromboprophylaxis • Hypertension • Cholesterol Management (statins) • Glucose • Rhythym • Carotid Stenosis • Lifestyle advice
• Young Stroke
• Antiplatelet therapy: • Clopidogrel
• Aspirin combined with Dipyridamole bd modified release