Stroke Flashcards
What is stroke?
Cerebrovascular accident (CVA)
Sudden onset of focal neurological deficit resulting from the interruption of blood flow
What is a transient ischemic attack (TIA)?
Focal neurological defect as a result of ischemia
Lasts <24 hours AND without evidence of infarction
What are the two types of strokes?
Hemorrhagic (13%) and ischemic (87%)
What happens in a hemorrhagic stoke?
Vessel ruptures
Higher death rate
Higher morbidity
Risk: aneurysm, HTN, meds
What happens in an ischemic stroke?
Plaque ruptures
20% atherosclerosis
30% cryptogenic
20% cardioembolic
25% lacunar (tiny vessels are affected)
5% other causes
What is a cardioembolic stroke?
Thrombi can break off and travel through aorta -> carotid artery -> small cerebral vessels
What causes a cardioembolic stoke?
Atrial fibrillation - clot can occur in left ventricle and travel to brain
Mechanical heart valves
What is the prevention method for cardioembolic stroke?
Use an anticoagulant
Warfarin, dabigatran, rivaroxaban, apixaban
what is the acute management of stroke?
Thrombolysis (fibrinolysis) - t-PA
Must be used within 3-4.5hours of onset
If not eligible for that then ASA
What is the secondary stroke prevention?
ABCDE
Antiplatelet therapy - ASA preferred
Blood pressure - ACE + THZ preferred
Cholesterol reduction
Diabetes
Exercise/lifestyle/smoking cessation
What are the first line drugs and target BP for HTN after stroke?
ACE+THZ
<140/90
What are the anti platelet agents for non-cardioembolic stroke?
First line: ASA or aggrenox
Second line: clopidogrel
What is the monitoring plan for ASA?
Signs: weakness, numbness, paralysis, vision, speech
AE: GI upset, bleeding, drug interactions
What is the prevention method for atrial fibrillation stroke?
OAC unless they also have coronary artery disease or PAD - then antiplatelet therapy
Treatment after TIA
ASA, statin, BP, warfarin (if atrial fibrillation)
