Stroke and AF Flashcards
(37 cards)
What are the two types of stroke?
- Ischemic - due to clot in the supply to the brain, accounts for 85% of cases.
- Hemorrhagic - bleed in the brain
How can you tell the difference between the two types of stroke?
CT scan
Name 5 modifiable risk factors for stroke
Diabetes Hyperlipidemia Smoking Alcohol Hypertension AF CHF
What is the most important modifiable risk factor for stroke?
Hypertension
How can we prevent stroke?
Identify a persons risk factors and modify them e.g. HTN ,smoking cessation, diabetes control
How can we predict someones risk of stroke after a TIA?
ABCD score
What does ABCD stand for in terms of stroke risk?
A - age > 60 years = 1 point B - blood pressure >140/90 = 1 point C - clinical features unilatereal weakness = 2 points Speech disturbances with no weakness = 1 point D- duration of symptoms >60 mins = 2 points 10-59 mins = 1 point <10 mins = 0 points
D- diabetes = 1 point
Why might dabigatran be unsuitable in stroke patients?
Large capsule so difficult to swallow.
Cannot go down and NGT or PEG
How can we increase the detection of AF in patients?
Regular manual pulse checks for the over 65s, particularly those with co-morbidities such as hypertension, heart disease, diabetes or renal dsyfunction.
How do we assess a person with AF risk of stroke?
CHA2DS2Vasc score
What does CHADVASc stand for?
C-congestive heart failure H- hypertension A- age >75 years = 2 points D- diabetes S - stroke or TIA = 2 points Vascular disease - 1 point Age between 64 and 75 - 1 Sex - female = 1
What does HASBLED stand for?
H - hypertension uncontrolled over 160
A - abnormal kidney or liver function (1 point for each)
S - Stroke history
B - bleeding (history of bleeding or predisposition
L - labile INR
E - elderly ?65 years
D - drugs/alcohol (1 point if taking antiplatelet drugs) and 1 point if consuming more than 8 drinks a week
When do we offer an patient with AF an anticoagulant?
If their CHADVasc score outweighs their HASBLED.
Anticoagulate if >2 points. (consider men with a score >1)
If a patient is taking warfarin but wants to switch to a DOAC what do you do?
Stop warfarin, and start DOAC once INR is <2
What DOAC might be the best option in elderly patients at risk of bleeding?
Apixaban - has the lowest bleed risk
When does the dose of DOACS need to be reduced?
Body weight (<60kg), renal impairment
Is aspirin suitable monotherapy for stroke prevention in AF?
NO - patient should stop aspirin and switch to DOAC or warfarin
What is the first line treatment for rate control in AF?
Cardioselective BB (if not suitable rate-limiting CCB)
When should digoxin be considered in AF?
Consider monotherapy for people only if they are sedentary and if there is no control with BB monotherapy
What is the acute management of stroke?
300mg aspirin for 14 days (stop any other antiplatelets during this time e.g. clopidogrel)
If a patient cannot swallow asprin what is a suitable alternative?
Rectal aspirin suppositories.
What is the initial management of recent onset (<48 hours) AF?
Revert them to sinus rhythm using electrical direct current (DC) cardioversion.
What are the symptoms of stroke?
Sudden numbness or weakness of face, arm or leg, especially on one side of the body
Sudden confusion, trouble speaking or understanding
Dizziness, loss of balance and co-ordination.
What is the difference between a TIA and a stroke?
Stroke is defined as a clinical syndrome of focal disturbance that lasts more than 24 hours. A TIA has the same symptoms but resolves within 24 hours.
