Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Block 8 week 4 > Primary Stroke Prevention - Larson > Flashcards

Primary Stroke Prevention - Larson Flashcards

1
Q

If you have one stroke are you more likely to have another?

A

Yes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Are the majority of strokes first events?

A

Yes, 76% are.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a TIA?

A

NOT a mini stroke. These are transient episodes of neurological dysfunction caused by focal brain, spinal cord or retinal ischemia without acute infarction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How long do most TIA’s last?

A

About 15 minutes. If the symptoms last for hours then there will most likely be infarcted tissue.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a stroke?

A

Brain, spinal cord, or retinal cell death attributable to ischemia, based on pathological, imaging, and/or clinical evidence of permanent injury.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Do strokes always have symptoms?

A

No. There are silent infarctions that produce no symptoms. These are also called overt brain infarctions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the two types of stroke risk factors?

A
  1. modifiable

2. non-modifiable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

List some non-modifiable risk factors for stroke.

A
  1. age - more common after age 50-55
  2. low birth weight
  3. ethnicity - Blacks, some hispanics have higher incidence rates and higher mortality rates
  4. genetics/family history
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What role does genetics/family history play in stroke risk?

A
  1. family history increases risk by 30%
  2. history of ischemic stroke before age 65 increases risk
  3. 8% of individuals with polycystic kidney disease and 7% of individuals with cervical fibromuscular dysplasia will have strokes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the modifiable risk factors for stroke?

A
  1. physical inactivity
  2. dyslipidemia
  3. HTN
  4. diabetes
  5. diet
  6. obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Non-invasive screening for unruptured aneurysms is indicated for what groups of patients?

A
  1. those with > than 2 first-degree relatives with SAH or intracranial aneurysms
  2. those with AD polycystic kidney disease and SAH or those with greater than 1 relatives with AD polycystic kidney disease and intracranial aneurysm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the association of physical activity with stroke risk.

A
  1. physically active people have 25-30% lower mortality than the least active
  2. routine physical activity prevents stroke
  3. physical activity - reduces plasma fibrinogen, reduces platelets activity, elevates tPA activity and elevates HDL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Healthy adults should perform at least moderate to vigorous intensity aerobic physical activity how often?

A

At least 40 minutes per day for 3-4 days a week.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe the association between dyslipidemia and stroke risk.

A
  1. statins can reduce risk in patients with or at high risk of atherosclerosis
  2. each 1% reduction in total cholesterol is associated with 0.8% reduction in risk of stroke
  3. plaque characteristics may improve with statins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

In patients with a high 10-year risk of cardiovascular events what is recommended?

A
  1. changes in lifestyle plus statins
  2. efficacy of niacin is not established
  3. efficacy of fibrin acid derivatives is not established
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe how diet and nutrition affect stroke risk.

A
  1. blacks are especially sensitive to the BP- raising effect of high salt intake, low potassium level and suboptimal diet
  2. there is a strong diverse relationship between servings of fruits and veggies and subsequent stroke
  3. increased intake of flavanoids from citrus fruits has been associated with reduced risk of ischemic strokes
  4. higher intake of red meat is associated with a higher risk of stroke
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are some diet recommendations that can lead to decreased risk of stroke?

A
  1. increased intake of potassium
  2. reduced intake of sodium
  3. increased intake of fruits, vegetables, nuts, low-fat dairy
  4. reduced intake of saturated fats
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the most important modifiable risk factor for stroke?

A

Hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe the association between HTN and stroke.

A
  1. the higher the BP, the greater the risk of stroke
  2. individuals who are normotensive at age 55 still have a 90% lifetime risk for developing HTN
  3. more than 2/3 of people over age 65 have HTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe the treatment of HTN.

A
  1. BP can be controlled in most patients but usually requires more than one drug
  2. HTN treatment is the most effective strategy to prevent both ischemic and hemorrhagic stroke
  3. treat to a target BP of less than 140/90 mmHg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Obesity rate is highest in what groups?

A
  1. blacks
  2. mexican- americans
  3. all hispanics
  4. lowest rate is whites
22
Q

Among overweight and obese individuals weight reduction is recommended for what?

A
  1. lowering BP

2. reducing risk of stroke

23
Q

Describe the association between diabetes and stroke.

A
  1. doubles the risk of stroke
  2. 20% of patients with DM will die of stroke
  3. hyperglycemia reduces platelet sensitivity to aspirin
  4. treatment of adults with DM with a statin is recommended to lower risk of first stroke
24
Q

What is the relationship between cigarette smoking and stroke?

A
  1. doubles the risk of stroke
  2. 2-4 fold increased risk for SAH
  3. synergistic effect exists between use of oral contraceptives and smoking on the risk of stroke
  4. second hand smoke is risk factor for heart disease
  5. there is a tobacco smoke exposure threshold rather than a linear dose-response relationship
  6. exposure is associated with the development of atherosclerosis
25
Q

Smoking as little as a single cigarette does what?

A
  1. increases heart rate
  2. increases mean BP
  3. decreases arterial distensibility
26
Q

What pharmacotherapy is particularly superior in smoking cessation?

A

Varenicicline or Chantrix. It is also more cost effective than nicotine replacement therapy.

27
Q

What is the association between A-fib and stroke?

A
  1. 4-5 fold increase in risk of ischemic stroke from embolism
  2. accounts for 10% of all ischemic strokes - even higher fraction in the very elderly (70 and older)
  3. CHADS2/CHADS2VASc - tool to evaluate the severity of risk
28
Q

Describe how treatment of A-fib decreases risk of stroke.

A

Tx w adjust-dose warfarin, target INR 2-3, reduces stroke
RR 64%
Reduces all-cause mortality by 26%
Reduces stroke severity and post-stroke mortality
Reduces stroke by 39% compared w aspirin

29
Q

Are the new oral anticoagulants better at reducing risk of stroke than Warfarin?

A

Yes - Examples are Dabigatran, Rivaroxaban, Apixaban, Edoxaban

30
Q

What are the advantages of the new oral anticoagulants?

A

Fixed dose
No blood monitoring
Fewer drug interactions than warfarin
Lower risk of ICH

31
Q

What are the disadvantages of the new oral anticoagulants?

A
  1. lack of reversing agents

2. short half life

32
Q

Describe some research findings regarding treatment of Afib and stable CAD.

A
  1. Warfarin/aspirin combo not recommend for AF and stable CAD
  2. combo of aspirin and plavix is better than aspirin alone
  3. warfarin is superior to combo of plavix and aspirin
  4. cardioversion, rate control, rhythm control do not protect AF patients agains stroke
  5. if have CHADS score of greater than one then anticoagulation is recommend
  6. if CHADS score is 0 or 1 then no treatment is necessary but aspirin may be considered
33
Q

Anticoagulant therapy is also reasonable for what populations?

A
  1. patients with STEMI and asymptomatic left ventricular mural thrombi
  2. patients with STEMI and anterior apical akinesia/hypokinesis
  3. for patients with cardiomyopathy either warfarin or aspirin is okay
  4. patients with mitral stenosis plus a prior embolic event
  5. patients with mitral stenosis with left atrial thrombus
  6. patients with mitral regurgitation
34
Q

Describe the association between valvular heart disease and risk stroke.

A

Risk of embolism higher if
Patients w rheumatic valve disease -Even if no AF
Risk of stroke is greatest within the first 3 months after prosthesis
Higher w mitral valves
Best to use warfarin x 3 months and then switch to aspirin if no other risk factors
Anticoagulant therapy does not reduce the risk of stroke in endocarditis - Increases risk of ICH

35
Q

Aspirin is reasonable therapy for what type of patient?

A

A patient with mitral valve prolapse and a previous TIA.

36
Q

What is recommended for the treatment of patent foramen ovale?

A

PFO is present in 15%-25% of the adult population
PFOs are not associated w subclinical cerebrovascular disease
No treatement is indicated for the primary stroke prevention in patients w PFO
Neither closure or anti-thrombotic therapy is indicated

37
Q

Describe the relationship between cardiac tumors and stroke.

A

Myxoma is the most common cardiac tumor
30%-40% of myxomas embolize
50% of patients w fibroelastoma present w stroke/TIA
Treatment is surgical excision

38
Q

Atherosclerotic plaques of what size are associated with increased risk of stroke?

A

Greater than 4 mm

39
Q

Warfarin and aspirin are indicated in what condition?

A

All mitral valve replacements.

40
Q

Patients with heart failure should get what type of meds to reduce stroke risk?

A

Warfarin or aspirin.

41
Q

Is population screening for patients with asymptomatic carotid artery stenosis recommended?

A

No. Statin therapy and daily aspirin is appropriate though.

42
Q

Stroke is a major complication of what disease?

A

Sickle cell disease. THe highest rates of stroke are in childhood and the prevalence of stroke by age 20 is 11%. Treatment is via periodic red cell transfusion to a target reduction of HbS of less than 30%.

43
Q

What is the association of migraine with aura and stroke risk?

A

Associated w stroke in young women <45 y old
Smokers
Use of oral contraceptives
Increased frequency correlated w increased risk of stroke
Also increased risk of ICH
Treatment = reduce migraine frequency and consider alternative contraception

44
Q

Heavy alcohol use is a risk for what?

A

All types of strokes. There is a linear association between alcohol consumption and the risk of ICH.

45
Q

What is the association between drug abuse and stroke?

A 
All sympathomimetics, cannabis, and heroin are associated w increased risk of stroke
BP elevations
Cerebral vasospasm
Vasculitis
Endothelial dysfunction
Increased blood viscosity
Platelet aggregation
46
Q

What is the association between sleep apnea and stroke?

A

4% of adults have sleep apnea
Sleep apnea is an independent stroke risk factor
Mainstay of therapy is CPAP
Patients who use CPAP have fewer strokes than patients who don’t

47
Q

What is the association between hyper coagulation disorders and stroke?

A

Acquired and hereditary hypercoagulable states (thrombophilias) are associated w venous thrombosis
The 2 most common genetic causes of thrombophilia are
Factor V Leiden mutation
G20210A prothrombin mutation
These coagulopathies are rarely associated w arterial ischemic stroke
Usefulness of screening or treatment is not well established

48
Q

Patients with RA or SLE are at risk of stroke. Why?

A

Inflammation has pro-thrombotic effects.

49
Q

Should everyone take aspirin to prevent stroke?

A

There is risk but no benefit of aspirin for the prevention of a first stroke in the general population

Aspirin is useful for MI prevention in certain populations, but not for stroke prevention

Aspirin is not useful for preventing a first stroke in low-risk individuals

50
Q

When is aspirin therapy recommended?

A

The use of aspirin for cardiovascular prophylaxis is reasonable for people w 10-year risk >10% - Not specific for stroke
Aspirin might be considered in patients with:
DM
Chronic kidney disease (Not severe kidney disease)

Block 8 week 4 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions