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Cardiology > Stroke > Flashcards

Stroke Flashcards

1
Q

What is stroke?

A

blood vessel disease
a BV gets affected
ischaemia/lack of blood flow to brain

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2
Q

What are focal neurological symptoms?

A
  • you can classify which area of brain is affected by the certain symptoms
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3
Q

What is the major burden of stroke?

A
  • rarely kills
  • causes disability
  • loss of independence
  • financial/family burdens
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4
Q

Name the 2 types of stroke

A
  • ischaemic (block of BV chasing hypoxia)

- haemorrhagic (rupture of BV chasing bleeding)

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5
Q

What is the most common variety of stroke?

A
  • ischaemic (80-85%)
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6
Q

Causes of hemorrhagic stroke?

A
  • high BP
  • weakened BV due to a) structural abnormalitites (e.g. anuerysm) b) arteriovenous malformation c) thrombolysis d) inflammation of vessel wall (vasculitis)
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7
Q

Causes of ischaemic stroke?

A
  • thrombus
  • embolic
  • hypoperfusion
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8
Q

What type of ischaemic stroke affects smaller BV?

A
  • thrombotic
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9
Q

What type of ischaemic stroke occlude larger BV?

A
  • embolic
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10
Q

What is hypo perfusion?

A
  • area of narrowing in blood vessel
  • requires systolic bp of ~140 to perfuse
  • drop in BP
  • not enough blood to supply brain
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11
Q

Describe mechanism of atherosclerotic stroke

A

risk factor - atherogenesis - plaque - rupture - platelets - thrombosis - ischaemia

or

plaque - vessel stenosis - low blood flow - ischaemia

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12
Q

Non-modifiable risk factors for stroke?

A
  • age
  • fam history
  • gender
  • race (South Asians)
  • previous stroke
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13
Q

Modifiable risk factors

A
  • HYPERTENSION
  • smoking
  • obesity
  • atrial fibrillation
  • inactivity
  • congestive heart failure
  • alcoholism
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14
Q

What treatment is recommended in all patients with ischaemic stroke?

A
  • statins

- reduces hyperlipidaemia

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15
Q

6 essential questions to consider when diagnosing stroke?

A
  • is this a stroke
  • what kind of stroke
  • what caused stroke
  • have you tried your best to answer q3
  • is patient on appropriate secondary prevention following investigation
  • have i answered patients questions
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16
Q

What conditions can stroke mimic?

A
  • hypoglycaemia
  • seizures
  • migraine
  • hyperglycaemia/ hyponatremia
  • space occupying lesson (e.g. brain tumours)
  • functional hemiparesis
17
Q

What should you look for on examination?

A
  • AF
  • signs of cardiac failure
  • neurological exam
18
Q

What is the only investigation to differentiate between types of stroke?

A
  • imaging
  • CT +/- angiography
  • MRI +/- angiography
19
Q

What investigations can diagnose an ischaemic stroke?

A
  • bloods
  • large BV occlusion: carotid scanning; CT/MR angiography of aortic arch (for atheroembolism)
  • cardioembolism: establish whether patient has AF; ECG (detects old ischaemic changes); left-ventricular hypertrophy
  • echocardiogram
20
Q

Where can embolic stroke arise from?

A
  • blood vessel: atheroembolism

- heart: cardioembolism

21
Q

How can we distinguish between athero/cardioembolism?

A
  • athero: infarcts dame side as affected carotid artery

- cardiac: infarcts in >1 arterial territory; bilateral

22
Q
  • investigation for hemorrhagic stroke?
A
  • imaging (investigate cause of bleeding)
23
Q

What type of hemorrhagic stroke can hypertension cause?

A
  • deep haemorrhage

- usually in older patients

24
Q

If a young person has a haemorrhagic stroke (who is normotensive?)

A
  • lobar haemorrhage
  • investigate for underlying aneurysm
  • arteriovenous malformation
25
Q

What is the medical management for stroke?

A
  • aspirin (75mg)
  • dipyridamole MR (200mg twice daily)
  • statins
  • anticoagulation in AF
  • anti-hypertensives (even in normotensives)
26
Q

What will stop future stroke?

A
  • antihypertensives (e.g. ACEI + diuretic)
27
Q

antihypertensives with 2 largest benefits against stroke?

A
  • perindopril

- indapamide

28
Q

Can surgery help stroke?

A
  • haematoma evacuation
  • relieves intracranial pressure
  • carotid endarterectomy: manages stroke disease

Cardiology (6 decks)

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