week 5 Flashcards
define stroke
Stroke is a clinical syndrome characterised by sudden onset of rapidly developing focal or global neurological disturbance which lasts more than 24 hours or leads to death.
define TIA
Transient ischaemic attack (TIA) — transient (less than 24 hours) neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without evidence of acute infarction
name 6 initial potential complications of a stroke
- Haemorrhagic transformation of ischaemic stroke.
- Cerebral oedema.
- Seizures.
- Venous thromboembolism — pulmonary embolism has been associated with 13-25% of deaths in the early period following stroke.
- Cardiac complications — cardiac complications (myocardial ischemia, congestive heart failure, atrial fibrillation, and arrhythmias) are common due to shared aetiology.
- Infection — people with stroke are at increased risk of infection including aspiration pneumonia, urinary tract infection, and cellulitis from infected pressure sores.
name 6 potential long term complications of a stroke
- hemiparesis (weakness of one side of the body)
- falls - due to ataxia (lack of co-ordination)
- sensory problems (touch, temperature, pain)
- dysphagia (raises issues in treatment- cannot swallow meds)
- urinary and faecal incontinence
- urinary incontinance can cause infections
what are the 4 steps for acute stroke care?
- admit to stroke unit
- imaging - CT scan- assess if haemorrhage or clot
- swallow (dysphagia may occur)
- assess meds- STOP all anticoagulants, thrombolytics, antiplatelets and NSAIDs pending CT result.
how long do we have to give thrombolysis?
4.5 hours from onset of symptoms
what are the dosing instructions for alteplase for a stroke?
- Dose = 0.9mg /kg (max dose 90mg)
- 10% of total dose as bolus over 2-3 mins
- 90% of total dose infuse over 60 mins
how long do we need to wait after thrombolysis before giving aspirin? what dose do we give when we continue?
- Leave 24h before giving aspirin- then give 300mg OD for 14 days
A-E secondary prevention of a stroke
antiplatelets
blood pressure
cholesterol
diabetes
exercise (and diet)
aspirin in stroke care
Aspirin given on the day of admission or the following day for all patients in whom a haemorrhagic stroke, or other contraindication has been excluded”
One off stat dose of aspirin 300mg
aspirin should be avoided for 24h post thrombolysis
anticoagulation after stroke
- for sinus rhythm patient
-for AF patient
*Patients in Sinus Rhythm
14 days aspirin 300 mg then clopidogrel 75 mg daily
Clopidogrel 75mg (unlicensed in TIAs)
*Patients in AF
Remember: x5 increased stroke risk
14 days aspirin 300 mg depending on impact of stroke
Anticoagulation is usually initiated 10-14 days after stroke
Remember also to alleviate symptoms of AF – rate control
blood pressure in stroke care
don’t want to decrease BP too much- this would reduce reperfussion (which we want)
only restart BP meds when patient is stable
cholesterol in stroke care- who should get statin, who should not??
- Atorvastatin 40 mg – 80 mg is used 1ST line
- Statins should NOT be used in patients with haemorrhagic stroke unless risk of vascular event outweighs risk of haemorrhagic event.
FAST
face drop - can they smile?
arms- can they lift both arms
speech- slurred? muddled?
time to call 999
define AF
supraventricular tachycardia characterised by disorganised atrial electrical activity
Resulting in absence of significant atrial depolarisation
No P waves on ECG
The ventricular rate is rapid and irregular
name 7 symptoms of AF
- Breathlessness
- Difficulty breathing
- Dizziness, light-headedness
- Palpitations
- Difficulty exercising (even just walking)
- Chest discomfort, pain (similar to angina pain)
- Tiredness, weakness
how can we diagnose AF? (5)
- ECG (used to diagnose as we can see irregular heart beat)
- Holter monitor (only used for a few days)
- Loop recorder (can be used for longer ie years)
- Echo (AF can cause damage to myocardium- use echo to see this)
- Blood test to check
Diabetes
Hyperthyroidism
Anaemia
Renal function
Infections (can trigger AF- particularly severe chest infection)
High cholesterol (doesn’t cause AF but part of CV risk)
what are the 2 options for alleviating symptoms of AF?
rate control
rhythm control
what is first line rate control in a patient with no other co morbidities?
beta blocker - atenolol
what are the 3 drug options for rate control in AF patients?
beta blocker (atenolol)
calcium channel blocker (verapamil)
digoxin
what would be first line in a AF patient who also has acute HF symptoms?
digoxin
what are the 2 drug options for rhythm control in AF?
amiodarone
flecainide
what would be first line for a young person with AF- for rhythm control?
flecainide (which is a sodium channel blocker)
what would be first line for an elderly person with AF- for rhythm control?
amiodarone
