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Cardio MT2 > MT2_11_Stroke > Flashcards

MT2_11_Stroke Flashcards

1
Q

What are the non-modifiable risk factors of stroke?

A

age
family hx
race (AA higher risk of death from stroke)
gender

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2
Q

For a thrombotic stroke what are the causes, and what to treat?

A
  • artherosclerosis from dyslipidemia
  • stenosis from dyslipidemia and hypertension
  • can occur in any blood vessel of the brain
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3
Q

For a lunacar stroke, what are the causes , and what to treat?

A
  • lipohyalinosis (fibroid lesion) from HTN and DM**
  • microatheroma (white clots) from hyperlipidemia
  • occurs in small vessels of the brain
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4
Q

For an artery to artery embolic stroke, what is It similar to ?

A

thrombotic stroke

  • artherosclerosis from dyslipidemia
  • stenosis from dyslipidemia and hypertension
  • small pieces of thrombi break from plaque and travel downstream to create a blockage
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5
Q

for a cardioembolic stroke, what are the causes and what to treat?

A
  • a clot is from the heart, stasis in the heart cause fibrin rich red clot to form, and the heart then ejects embolus to brain
  • atrial fibrillation most common

and other etiologies related to systemic clot formation

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6
Q

When can a venous clot cause a stroke?

A
  • when there is direct passage from the R atrium to the Left
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7
Q

What are the main clinical presentations of a stroke?

A
  • sudden neurological deficit

such as numbness, weakness, confusion, difficulty speaking, aphasia (gibberish), changes in vision

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8
Q

How can stroke be assessed?

A

NIHSS scale

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9
Q

For diagnostic testing, what else can be looked at?

A

BP, HR, GLUCOSE, PT/INR, CBC, BMP, ECG

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10
Q

What happens in an acute ischemic stroke?

A
  • neurologic emergency due to an occlusion of a blood vessel, decreasing oxygen supply to he brain. Target the clot
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11
Q

What is the primary treatment for an ischemic stroke? When is it given?

A
  • tPA, aspiring if tPA is not given

- is usually given less than4.5 hours from onset

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12
Q

tPA inclusion criteria?

A
  • diagnosis of an ischemic stroke causing a neurological deficit
  • onset of symptoms less than 3 hours before beginning treatment
  • greater than 18 years
  • BP lowered to less than 185/110 and stable
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13
Q

When should tPA not be given?/ CI?

A
  • significant head trauma in the past 3 months
  • symptoms suggesting hemorrhage
  • head CT with hemorrhage
  • history of prev intracranial hemorrhage
  • CT brain imaging with regions of irreversible injury
  • intracranial or intraspinal surgery
  • intra-axial neoplasm
  • internal bleeding
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14
Q

What are other CIs to tPA?

A

● Acute bleeding diathesis
– Platelet count < 100k
– INR > 1.7, PT > 15 seconds
– aPTT > 40 seconds
– Treatment dose of LMWH within the previous
24 hours
– Use of direct thrombin inhibitors or direct factor
Xa inhibitors unless lab parameters normal (or
> 48 hours since last dose)
– Concomitant use of GPIIb/IIIa receptor inhibitor

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15
Q

What is the exclusion criteria of taking tPA within 4.5 hours from symptom onset?

A

over 80
severe strike
taking an oral anticoagulant
history of DM and prior ischemic stroke

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16
Q

Regarding BP control, what is the goal BP if giving tPA? If not?

A
  • less than 185/110

- if not, up to 220/120

17
Q

What is the dosing of tPA in an acute ischemic attack?

A
  • 0.9 mg/kg in one hour, with 10% given as bolus over 1 minute
18
Q

What are the side effects of tPA?

A

bleeding, anaphylaxis, orolingual angioedema, cholesterol embolization

19
Q

When to monitor for tPA? How often should you check BP? BP goal?

A
  • monitor for severe bleeding (headache, acute HTN, N/V
  • every 15 minutes for 2 hours
  • goal of less than 180/105
20
Q

What is a hemorrhagic transformation?

A
  • cells and tissues die, and inflammation develops around the area
  • blood flow is stopped/decreased to the brain, and so when there is a sudden return of BP, the reperfusion can break through the clotted dead tissue and bleed into the head, causing a hemorrhagic transformation
  • risk factors: large stroke, high BP, use of fibrolynics, anitplatelets, antifibrinolytics
21
Q

For a subacute stroke (inpatient) what are the steps of treatment?

A
  1. Antiplatelet (aspirin within 24-48hrs if TPA given with 24 hours after, clopidogrel, aspirin and clopidogrel for 21 days)
  2. BP Control (if getting tPA, less than 185/110, maintain less than 180/105) if not getting tPA decrease bp by 15%, can restart HTN therapy if BP is greater than 140/90
  3. BG Control (goal of 140-180)
  4. Statin continue, due to anti-inflammatory and neuroprotective properties)
  5. Supportive Care (oxygen, body temp, fluid restriction..ensure adequate perfusion, correct hypovolemia w NS 0.9%
  6. Additional Diagnostic Tests (Protein C, S, anithrombin, lupus, anticoagulant, ECG, blood vessel imaging)
  7. Potential Complications (infections, DVT/PE, ulcers, dysphagia, seizures)
22
Q

Transient ischemic attack

A
  • aka a mini stroke, temporarily blocks blood flow
23
Q

For a carotid artery stenosis?How to treat

A
  • if there is a complete occlusion, no treatment, allow collateral artery to provide flow and ensure potency
  • if partial occlusion, surgically remove (carotid endarterectomy) or angioplasty or prescribe meds
24
Q

For a cranial/cervical artery dissection, what happens?

A
  • a tear in the vessel wall, results in clot formation due to trauma or falls, resulting in a higher risk of clot mobilization
  • treat with anti platelet or anticoagulation (warfarin, heparin, aspirin, clopidogrel)
25
Q

What are the steps to secondary prevention for noncardioembolic stroke?

A
  1. anti-platelet (aspirin, aspirin + dipyridamole (Caution in elderly, recent MI or unstable angina) s/e of headache/bleeding, and dose aspirin 25mg+dipyridamole 200mg POVID, clopidogrel 75mg PO QD, cilostazol: CI in CHF patients, 100mg BID)
  2. antihypertensive
  3. antihyperlipidemic
  4. lifestyle modifications (blood glucose, smoking, alcohol consumption, obesity and PE)
26
Q

For fib anticoagulation, how does anticoagulation therapy work?

A
  • use oral anticoags: warfarin (goal INR 2-3), dabigatrin (DTI), rivaroxaban apixaban, endoxaban (factor 10)
  • antiplatelts only if patient CANT be treated with anticoags
27
Q

What are the factors in choosing an anticoagulant in patients/

A
  • compliance, diet, CKD, reversibility
28
Q

For hemorrhagic stroke, what is an intracerebral hemorrhage? subarachnoid hemorrhage?

A
  • bleeding directly into brain tissue

- bleeding beneath arachnoid mater

29
Q

What are the risk factors for intracerebral hemorrhage?

A
  • HTN, age, smoking, alcohol, low LDL, fam hx
30
Q

What are the symptoms of intracerebral hemorrhage?

A
  • headache
  • decreased level of consciousness
  • vomiting
  • seizure
31
Q

How to manage intracerebral hemorrhages?

A
  • BP control goal of 40
  • maintain cerebral perfusion pressure 70-80 (CPP = MAP-ICP)
  • titratable meds, nicardipine, nitroprusside
32
Q

For secondary prevention of intracerebral hemorrhage, what to do?

A
  • maintain HTN BP less than 130/80
  • lifestyle modification (alcohol, tobacco, drug use)
  • timing of restarting anticoagulation or anti platelet agents
33
Q

What causes a subarachnoid hemorrhage?

A
  • primary aneurysmal rupture
34
Q

What are the risk factors for a subarachnoid hemorrhage?

A 
● Hypertension
● Smoking
● Family history
● Alcohol consumption
● Oral contraceptive use
● Pregnancy
● Childbirth
● Illicit drug use (cocaine,
methamphetamines)
35
Q

Symptoms of a subarachnoid hemorrhage?

A
  • worst headache of one’s life
  • nausea/vomiting
  • neck pain
  • altered LOC
  • seizures
36
Q

What is the goal of therapy fora. subarachnoid hemorrhage?

A
  • prevent rebreeding , prevent vasospasm (narrowing of the vessel)
37
Q

How to manage rebleeding? vasospasm?

A
  • for rebreeding, surgical intervention, and aminocaproic acid
  • vasospasm: nimodipine 60mg PO q4H for 21 days
    augment cerebral circulation (hypervolemia, hemodilution, HTN therapy)
38
Q

What are other complications of a stroke?

A
  • infections
  • DVT/PE
    Seizure
  • dysphagia

Cardio MT2 (12 decks)

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