Let s talk about: Stroke

Transcription

1 Let s talk about: Stroke February 20 th 2013 Laura Wilson Christine Stables Questions 1. Why is knowing about stroke important? 2. What exactly is a stroke and what are the symptoms? 3. What should I do if I or someone is having a stroke? Stroke is common 4. Is there treatment? 5. How can I prevent a stroke? Why do we care? Why do we care? Stroke is the 3 rd leading cause of death in Canada Each year 14,000 Canadians die from stroke Each year more women than men die from stroke Over 50,000 strokes occur in Canada every year that s 1 every 10 minutes About 300,000 Canadians are living with the effects of a stroke disability is important! STROKES CAN BE TREATED STROKES CAN BE PREVENTED

2 What is a stroke? A stroke is an injury to the brain from lack of blood supply Sudden loss of brain function STROKE = BRAIN ATTACK This may be due to an artery being cut off/clogged (ischemic stroke) or an artery bleeding into the brain (hemorrhagic stroke) What is a stroke? Other terms you may hear relating to stroke: Cerebrovascular Accident (CVA) Transient Ischemic Attack (TIA) What causes a Stroke? Blood clots can form in the blood vessels of the neck and travel to the brain Mini-stroke Lacune or Lacunar Stroke Intracerebral Hemorrhage Subarachnoid Hemorrhage What causes a Stroke? Blood clots can form in the heart and travel to the brain During atrial fibrillation After a heart attack What causes a Stroke? Blood vessels may rupture within the brain Aneurysms High Blood Pressure With valve disease

3 What are the symptoms of a Stroke? The symptoms of a stroke depend on which part of the brain is injured or dying due to lack of blood supply or bleeding Weakness or Numbness SUDDEN Vision loss Problems with Speech and Language NO PAIN FAST VIDEO -- Australia zk Example of Speech disturbance Aphasia I

4 Why Act Fast? For every 1 minute delay in treatment 1.9 million brain cells are lost There is treatment available for stroke in the first 4.5 hours intravenous tissue plasminogen activator (tpa) tpa = the clot buster tpa (alteplase) works by dissolving clots that are blocking arteries within the brain The goal is to restore blood flow to improve symptoms of a stroke Approved for treatment of an ischemic stroke within 4.5 hours of symptom onset Benefit decreases over time the earlier the better! Other potential treatments Intra-arterial tpa Mechanical Thrombectomy Carotid Endarterectomy Stroke Prevention There are some factors that we cannot change Age Gender Family history Ethnicity But many important ones that we can modify to reduce our risk of stroke! Atrial Fibrillation An irregular heart rhythm The top two chambers of the heart, the atria do not contract in coordination with the bottom two chambers, the ventricles This may cause turbulent movement of blood between the chambers leading to the formation of blood clots Causes of Atrial Fibrillation High blood pressure Abnormal heart structure Infection or inflammation of the heart Diseases that damage the valves of the heart Overactive thyroid A blood clot in the lung Congenital heart disease Overuse of alcohol Triples the risk of stroke

5 Atrial Fibrillation Diagnosis of Atrial Fibrillation People may not even notice it occuring May cause the following symptoms Irregular and fast heartbeat Palpitations Chest discomfort, pain or pressure Shortness of breath Fatigue Dizziness, sweating or nausea If you notice your heart is fast and/or irregular, ask your doctor to check your heart rate Heart rate and stethoscope examination ECG Holter a 24 hour ECG Echocardiogram Light headedness or fainting Treatment of Atrial Fibrillation Blood thinners Rhythm control Rate control Healthy lifestyle Blood Thinners Asprin or Plavix Antiplatelet agents Lowers your stroke risk by 20% if you ve had a prior stroke Warfarin Coumadin lowers your risk of stroke by 60% Thrombin inhibitor prevents the blood from clotting Inhibits the action of vitamin K and its effectiveness can be altered by certain foods Needs to be regularly monitored with blood tests Blood Thinners New Oral anticoagulants Dabiagtran, Apixiban, Rivaroxaban Act to inhibit the blood from clotting Are not affected by diet Do not need regular monitoring blood tests ** All blood thinners carry the risk of bleeding and need to be discussed with your doctor to determine which is the best choice for you ** Hypertension High Blood Pressure Blood pressure measures the force of blood against the walls of your blood vessels Systolic is the pressure measured when your heart is contracting Diastolic is the lowest pressure measured when your heard is relaxing between beats

6 Hypertension Hypertension Over time high pressure in the blood vessel walls can cause scarring to the surface of the blood vessel Scarring can promote buildup of fatty plaque (atherosclerosis) The buildup can cause narrowing or blockages in the arteries Lowers your risk of stroke by 30% Treatment for Hypertension Blood pressure should be checked by your doctor or another qualified health care professional Take medication as prescribed by your doctor Follow the lifestyle recommendations Cholesterol One of the fats in your body used to make cell membranes, vitamin D and hormones Two types of cholesterol 1. Low-density lipoprotein (LDL) Bad Cholesterol High levels in the blood promote buildup of plaque 2. High-density lipoprotein (HDL) Good Cholesterol Helps carry LDL away from the artery walls Treating High Cholesterol Your doctor may prescribe a cholesterol lowering medication Reduce your fat intake to 20-35% of your daily calories Choose healthy fats such as vegetable oils, nuts and fish Limit your intake of saturated fat, red meat and high fat dairy productes Avoid trans-fats found in many baked goods Diabetes Diabetes is a major risk factor for stroke Type 1 diabetes develops when the pancreas does not produce insulin Type 2 diabetes develops when your body tissues are not able to effectively use the insulin your body produces Lowers your risk of stroke by 20%

7 Diabetes Have your fasting blood glucose checked by your doctor Work closely with your doctor to set goals for your blood glucose You may need medications to help lower your blood sugar as well as insulin Lifestyle Factors Exercise Diet/Nutrition Alcohol Weight management Smoking Stress Exercise Make physical activity part of your life At least 30 minutes most days of the week Walking Gardening Playing with your kids or grandkids Diet/Nutrition Canada s food guide to ensure you are getting adequate nutrients Moderation is key Seek out resources and support in achieving your dietary goals Household chores washing the car, etc. Exercise groups Alcohol Overuse of alcohol increases your blood pressure and contributes to heart disease and stroke Limit yourself No more than 2 drinks a day to a weekly max of 10 for women and 3 a day to a weekly max of 15 for men Measure your portions 12oz/341mL, 1 bottle of beer (5% alcohol) 5oz/142mL of wine (12%) 1 ½ oz/43ml spirits (40%) Weight management Diet is the biggest contributing factor Exercise will also help with weight maintenance Measure your waist circumference Less than 40 inches/102 cm for men Less than 35 inches/88 cm for women Measure your Body Mass Index (BMI) Goal to be between 18.5 and 25

8 Smoking Contributes to buildup of plaque in your arteries increases blood pressure increases the risk of blood clots makes your heart work harder reduces the amount of oxygen in your blood. Smoking Immediately reduces your risk of heart attack and stroke Immediately improves healing time Within one year of quitting the risk of dying from smoking related heart disease is cut in half Quitting Smoking Conclusion Stroke is a common disease in our society this includes both ischemic and hemorrhagic types of stroke Symptoms of a stroke depend on what part of the brain is being affected and need to be recognized FAST Treatment exists with tpa in the first 4.5 hours after a stroke begins Conclusion Non-modifiable stroke risk factors include age, gender, ethnicity, genetics Modifiable stroke risk factors include Afib, hypertension, cholesterol, diabetes, smoking and other lifestyle factors Resources Heartandstroke.ca Uptodate.com Medications can be used to lower the risk of stroke in addition to changes in lifestyle