Hypertension and stroke Flashcards Preview

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Flashcards in Hypertension and stroke Deck (12)

What can persistently high blood pressure cause?

– Stroke (hypertension is the most modifiable risk for stroke)
– Heart disease – Renal disease – Visual failure
– ...death
There are often no signs until something drastic happens


How can you test blood pressure?

• Sphygmomanometer • Initial high readings • Retest
• Refer to GP
• Also look for secondary effects – ECG
– Renal function – Eyes – Ix for secondary causes


How should high bp be managed?

Lifestyle changes only start prescribing medication if there's persistent bp of 160/90mmHG .
beta blockers, calcium channel blockers, statins, ACE inhibitors


What's the burden of stroke?

It's the leading cause in hospital mortality
Second leading cause of death
Major cause of acquired disability


Some pointers to help you know it's a stroke?

• Acute and sudden onset of symptoms
• Focal neurological deficit not global
• Pattern of symptoms and signs attributable to one part of the brain and a particular vascular supply


What's a TIA?

• Differs from stroke only in duration.
• Brief episode of neurological dysfunction caused by focal brain or retinal ischaemia; symptoms lasting typically less than an hour, without evidence of infarction.
– Many patients with TIA’s lasting more than two hours will have infarction on MRI scan
• Requires urgent assessment as many high risk for full CVE


What's the ABCD2 score?

Stratifies the risk of stroke • Based on simple clinical observations • may be appropriate to admit and assess.
It can predict whether a stroke will take place in the next two days.


What are the different types of stroke?

TACI-embolism-poor outcome
PACI-embolism-good outcome
LACI-small vessel disease-fair outcome
POCI-variable mechanism and variable outcome


What are the modifiable risk factors for ischaemic stroke?

• Hypertension
• Diabetes
• Smoking
• Hyperlipidemia
• Carotid stenosis
• Atrial fibrillation


Management of stroke?

F-facial palsy, which side?
A-arm weakness, which side?
• General medical care on a STROKE UNIT —NNT 12
• If Infarct Aspirin 300mgs OD. (Add Dipyridamole Retard within 2 weeks)
• Swallow assessment • Pressure sore prevention/TED stockings • Hydration and nutrition • Antipyretic • Active glucose monitoring and lowering if raised
• Physiological monitoring


What is a stroke unit?

• Care co-ordinated by a multidisciplinary team
• Team meets to discuss patients at least weekly
• Nurses have expertise in rehabilitation
• Team consists of professionals interested in and specialising in stroke
• Regular in-service training for staff is provided
• Involvement of carers in patient care


What's secondary prevention of a stroke?

• Thromboprophylaxis • Hypertension • Cholesterol Management (statins) • Glucose • Rhythym • Carotid Stenosis • Lifestyle advice
• Young Stroke
• Antiplatelet therapy: • Clopidogrel
• Aspirin combined with Dipyridamole bd modified release