Lopez: Primary Stroke Prevention Flashcards by Megan Foggia

Approx (blank) adults experience an ischemic stroke each year

800,000

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76% of (blank) are first events

strokes

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4th leading cause of death in the US

stroke

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Transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia. w/o acute infarction
Most last 15 minutes

transient ischemic attack

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T/F: The longer the symptoms last in a stroke, the more likely the MRI will show lesions

True

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Brain , spinal cord, or retinal cell death attributable to ischemia, based on pathological, imaging, and/or clinical evidence of permanent injury

Stroke

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Silent infarction produces no (blank)

symptoms

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What are some non-modifiable risk factors for stroke?

age
low birth weight
ethnicity (black, some hispanics)
genetics/family history
history of ischemic stroke before age 65

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Intracranial aneurysms occur in 8% of individuals with (blank) and 7% of individuals with (blank)

polycystic kidney disease;

cervical fibromuscular dysplasia

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Who should get non-invasive screening for unruptured intracranial aneurysms?

patients with >2 first degree relatives with subarachnoid hemorrhage or intracranial aneurysms

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Modifiable risk factors for stroke?

physical inactivity
dyslipedemia
HTN
diabetes mellitus
diet 
obesity

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Physically active people have 25-30% lower mortality than those who are less active. How does physical activity reduce your risk?

reduces plasma fibrinogen
reduces platelet activity
elevates tPA
elevates HDL

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Healthy adults should perform at least moderate to vigorous intensity aerobic physical activity at least (blank) min/d, (blank) d/week

40 minutes; 3-4 days

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Tx w (blank) reduces the risk of stroke in patients w or at high risk for atherosclerosis

statins

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Beneficial effects are greater w greater lipid lowering

Each 1% reduction in total cholesterol is associated w (blank) reduction in the risk of stroke

0.8%

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Primary prevention of ischemic stroke in patients with high 10 year risk for cardio events?

changes in lifestyle + statins

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Effects of the following are not established for decreasing cardiovascular events

niacin

fibric acid derivatives

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(blank) are especially sensitive to the BP-raising effect of high salt intake, low potassium level, and suboptimal diet

blacks

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There is a strong diverse relationship between servings of (blank) and subsequent stroke

fruits and veggies

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Higher intake of (blank) has been associated w a higher risk of stroke

red meat

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This kind of diet may be beneficial in those at risk for stroke

DASH-style diet/Mediterranean diet

*high fruits, veggies, nuts
low-fat dairy
reduced saturated fats

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The higher the (blank) is, the greater the risk of stroke

blood pressure

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Prevalence of HTN in the US

29%

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most important, well documented modifiable risk factor for stroke

HTN

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most effective strategy to prevent both ischemic and hemorrhagic stroke

HTN treatment

Recommendations for blood pressure treatment

treat to target BP <140/90mmHg

Highest rates of obesity in these pops? | Lowest rates?

Blacks, Mexi-Americans, all Hispanics; | whites

Among overweight and obese individuals, (blank) is recommended for lowering BP and for reducing the risk of stroke

weight reduction

This disease more than the doubles the risk for stroke

Diabetes Mellitus

What happens to DM patients taking aspiring?

their hyperglycemia reduces platelet sensitivity to aspirin

What is recommended for adults with diabetes mellitus to reduce incidence of stroke?

statins

Cigarette smoking (blank) the risk for stroke and causes a 2-4 fold increased risk for (blank)

doubles; subarachnoid hemorrhage

T/F: There is a tobacco smoke exposure threshold rather than a linear dose-response relationship

True

Smoking as little as a single cigarette increases (blank), (blank), and decreases (blank)

heart rate; mean BP; arterial distensibility

Both active and passive exposure to cigarette smoke is associated w the development of (blank)

atherosclerosis

Drug used for smoking cessation

Varenicicline

Those with this condition have a 4-5 fold increase risk of ischemic stroke resulting from embolism

atrial fibrillation

Atrial fibrillation accounts for 10% of all (blank)

ischemic strokes **even higher in the elderly

What is the CHADS2?

``` 1 point for each: CHF HTN Age >75 Diabetes Mellitus ``` 2 points for: prior stroke or TIA 0 points: low risk 1 point: moderate risk >1 point: high risk

How is CHA2DS2VASc different from CHADS2?

adds an age category 1 point for age 65-74 2 points for age >75 also add 1 point for: vascular disease female sex

How does the HAS-BLED scoring work? What is this test used for?

``` Score 0-9 Score > 2 associated w major bleeding 1 point each for HTN Abnormal renal function Abnormal liver function Prior stroke Prior major bleeding/bleeding predisposition INR in therapeutic range 65 Use of anti-platelets or NSAIDs Excessive alcohol use ``` **this tells you how likely a patient is to bleed on anti-coagulants

How to treat Atrial fibrillation?

adjust-dose warfarin to an INR between 2-3

What does warfarin do for stroke pts?

reduces all cause mortality reduces stroke severity and post-stroke mortality reduces strokes

Advantages of newer anti-coagulant drugs when compared to warfarin?

fixed dose no blood monitoring fewer drug interactions lower risk of intracerebral hemorrhage

Disadvantages of newer anti-coagulant drugs when compared to warfarin?

lack of reversing agent | short half-life

T/F: combination of Plavix and aspirin is superior to aspirin alone

True

Should warfarin + aspirin be used for patients with atrial fib or stable CAD?

T/F: Cardioversion, rate control, rhythm control protect AF patients against stroke.

False!!

If your CHADS score is >1, what should you do? If it is between 0-1, what should you do?

anticoagulation; | no treatment or aspirin

present in 15%-25% of the adult population | not associated w subclinical cerebrovascular disease

patent foramen ovale

Is treatment (aspirin) indicated for primary stroke prevention in patients with patent foramen ovale?

Most common cardiac tumor

myxoma

What should we do for patients with asymptomatic carotid stenosis (picked up via screening)?

statin therapy + aspirin

Less well-documented risk factors

``` Migraine (w aura) Metabolic Syndrome Alcohol consumption Drug abuse Sleep-disordered breathing Hyperhomocystenemia Hypercoagulability Inflammation and infection Antiplatelet agents/aspirin ```

Associated w stroke in young women <45 y old Smokers Use of oral contraceptives

migraine w aura **overall, low incidence of strokes in these women, but compared to women who don't smoke or use OC

Recommendations for women with migraine auras?

use alternative BC, esp those with estrogen | reduce migraine frequency

This is a risk factor for all types of stroke

heavy alcohol use

There is a linear association between alcohol consumption and the risk of (blank)

intracranial hemorrhage

All sympathomimetics, marijuana, and heroin are associated w increased risk of (blank)

stroke

This is an independent stroke risk factor

sleep apnea **4% of general population

Mainstay of therapy for sleep apnea

CPAP

T/F: Effectiveness of decreasing homocysteine serum levels has proven to decrease stroke risk

FALSE

Acquired and hereditary hypercoagulable states (thrombophilias) are associated w (blank)

venous thrombosis

Where is the stroke belt?

Southern states

~85% of strokes are (blank), while 15% are (blank)

ischemic; hemorrhagic

Two causes of ischemic stroke?

thrombotic | embolic

T/F: 10% of ischemic strokes due to A fib

True

Most commonly used classification for ischemic strokes

TOAST | trial of acute stroke treatment

Different types of ischemic stroke

``` Large artery atherosclerosis Cardioembolism Small-vessel occlusion Stroke of other determined etiology (i.e.,dissection) Undetermined etiology ```

Obstruction of blood flow due to localized occlusive process | Atheromatous plaques can obstruct the orifices of penetrating arteries

thrombosis

Smaller, penetrating vessels (lenticulostriate) more often damaged by (blank) than by the deposition of atheromas (atherosclerosis)

HTN

5 causes of ischemic strokes

``` large artery atherosclerosis cardioembolism small-vessel occlusion stroke of other determined etiology undetermined etiology ```

Lopez: Primary Stroke Prevention Flashcards

(72 cards)