Brainscape's Knowledge GenomeTM

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


See full index

Clinical Year 4 > Stroke and Atrial Fibrillation > Flashcards

Stroke and Atrial Fibrillation Flashcards

1
Q

What is the definition of a stroke?

A

A syndrome of rapidly developing clinical signs of focal disturbance of cerebral function, with symptoms lasting 24 hours or longer or leading to death. With no apparent cause other than of vascular origin.

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

What is the definition of a TIA?

A

Same as stroke but lasting less than 24 hours

In a TIA, the blood clot that is blocking the flow of blood in the brain breaks up on its own and the symptoms disappear after a short period of time.

TIAs generally don’t cause severe brain damage, but they are a warning sign of a future stroke and should be taken seriously. Even if symptoms disappear quickly, it is important to seek medical care immediately to prevent a future major stroke.

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

What are the main signs/symptoms of stroke?

A

Face - drooped on one side
Arms - unable to lift both arms
Speech - slurred or garbled

Others

  • paralysis on one side of the body
  • sudden loss of or blurred vision
  • dizziness
  • confusion
  • difficulty understanding what other people are saying
  • problems with balance and co-ordination
  • difficultly swallowing
  • a sudden and very severe headache
  • loss of consciousness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the main lifestyle risk factors for stroke?

A

High body weight

Smoking

High alcohol intake

Diet

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

What are the main medical risk factors for stroke?

A

Hypertension

Atrial fibrillation

High cholesterol

Diabetes

Infection

Circulation problems

Carotid artery disease

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

What are the main uncontrollable risk factors for stroke?

A

Age over 55

Gender (females at higher risk)

Ethnicity (African americans at higher risk)

Family history

Previous stroke

Recent TIA

Fibromuscular Dyplasia (FMD)
- blood vessels not as developed

Patient Foramen Ovale (PFO)
- hole in the heart

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

What is the ABCD^2 score?

A

Score to predict risk of stroke after TIA

Look at separate sheet!

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

What strategies are normally used for primary prevention of stroke?

A

Hypertension treatment

Smoking cessation

Cholesterol (Statin?)

Reduced alcohol intake

Diabetes control

Diet & Exercise

Warfarin for Atrial Fibrillation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What strategies are normally used for secondary prevention of stroke?

A

Aspirin 300mg OD for 14 days (24 hours post thrombolysis) then Clopidogrel 75mg OD

Hypertension treatment

Statins (consider for cholesterol >3.5mmol/l)

Carotid endarterectomy for patients with symptomatic carotid stenosis

Anticoagulant therapy for patients with Atrial Fibrillation

Smoking Cessation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Stroke is a serious complication of AF…

A

Stroke in AF is associated with a heavy burden of morbidity and mortality

AF stroke is usually more severe than other strokes

  • more likely to experience disability and have a longer stay in hospital
  • More likely to be discharged to a care home

The mortality rate for patients with AF is about double that in people with normal heart rhythm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

CHADSVASc risk criteria

A

Risk of stroke in patients with AF

  • Look at separate sheet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

HASBLED score

A

Risk of bleeding in patients with AF

  • See separate sheet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

RCP guidelines for thromboprophylaxis in AF

A

CHA2DS2-VASC = 0: no treatment

Score 1 or more consider anticoagulation

Aspirin should NOT be used: ineffective

Assess risks versus benefits:

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

What are the main disadvantages of using Warfarin?

A

Narrow therapeutic window

Administrative burden to NHS

Inconvenience of INR testing

Dietary/drug interactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the main advantages of using Warfarin?

A

Cheap

Familiar

Easily reversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What monitoring do you need for NOACs?

A

Renal function
Liver function
BP
Prothrombin time

17
Q

What advice should be given to patients who have had a TIA?

A

Driving

  • Private Car - May not drive for 1 month
  • PSV/HGV - May not drive and must report to DVLA

No contraindication for flying but airlines may be reluctant for 1 month

No restriction on occupation but may need to be assessed by occupational health

18
Q

What is the acute treatment of stroke?

A

General medical care

  • Hydration
  • Management of dysphagia
  • Oxygen therapy
  • Blood pressure (B-block and Nimodipine have no benefit - do have benefit in ICH though)
  • Venous thromboprophylaxis

Aspirin
- Started within 48 hours

Re-perfusion/Thrombolysis

Neuroprotection?

19
Q

What should NOT be offered for stroke prevention in patients with AF?

A

Aspirin monotherapy

Need to give Warfarin or NOACs

20
Q

Considerations for

anticoagulation in patients with AF and have had a stroke or TIA

A
  • Should not be given after stroke or TIA until brain imaging has excluded haemorrhage
  • After haemorrhage ruled out, treatment should begin immediately with a LMWH or NOAC
  • Should not be commenced in patients with uncontrolled hypertension
21
Q

What are the main symptoms of AF?

A

Light-headedness
Syncope
Fatigue

Palpitations
Dysnea
Chest Pain

Thrombo-embolism
Death

22
Q

What should be monitored in patients with AF?

A 
TFT
FBC
U&Es
BG
BP

Manual pulse check
- ECG if irregular

23
Q

What is first line for patients with AF?

A 
Rate control (Monotherapy) 
- B-blocker or RL-CCB

& Anticoagulation

24
Q

What is second line for patients with AF?

A

Rate control (Dual therapy)

  • B blocker
  • Diltiazem
  • Digoxin
25
Q

What is third line for patients with AF?

A

Rhythm control strategy
- Pharmacological
(Bisprolol, Amiodarone, Flecainide or Sotolol etc)
- Electrical cardioversion

26
Q

How do B-blockers control heart rate?

A

They slow conduction through the AV node

27
Q

What happens if patients have previously been prescribed a standard B-blocker and they get new onset AF?

A

Consider an alternative agent

- Straight to rhythm control (Amiodarone or Sotalol)

28
Q

What do you prescribe after a patient has had a TIA?

A

Start aspirin, clopidogrel and statin immediately

  • Aspirin STAT 300mg loading dose (1 time only) and Clopidogrel 75mg OD permanently
29
Q

How quickly do you refer a patient who has had a TIA to a specialist?

A

ABCD2 score less than 4 = within 7 days

ABCD2 score greater than or equal to 4 = within 24 hours

Clinical Year 4 (12 decks)

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