Stroke Management
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| Stroke Risk Factors | older age (every decade over age 55, risk doubles), men (more women die from stroke), AA, hispanic, obesity, alcohol abuse, smoking, poor diet/nutrition
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| Modifiable risk factors | HTN, atrial fib, carotid stenosis, diabetes, hyperlipidemia, prior stroke, TIA
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| How much can weight reduction lower bp? | up to 20mmHG/10kg weight loss
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| Single most treatale risk factor for stroke | High bp
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| What percentage Risk Reduction is acheivable with aspirin? | 22%
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| Warfarin vs Aspirin | Warfarin has better risk reduction (45%).
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| CHADS pneumonic | CHF, HTN, Age >75, Diabetes, Stroke of TIA. (6 possible points. 3 is high treat with warfarin. Moderate =2 points, can argue either way with warfarin. Below 2, treat with aspirin)
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| If CHADs score is 2 from previous stroke, tx with | Warfarin.
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| % stenosis = 1- (A/B), what is A? | A is the area of tightest narrowing. B is the normal width
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| What is the impact of tight glucose control on macrovascular complications? | none. Macrovascular complications not affected by glucose control. Tight control of HTN is the goal.
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| Cholesterol and RR | No evidence that lowering cholesterol overall affects stroke incidence. But if you use statins in patients with CHD, there is a risk reduction
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| Aspirin in low-risk pts | no data to support using Aspirin. Risk outweighs benefit (bleeds). Aspirin recommended for 10-yr cardiovascular risk 6-10%
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| Only FDA approved therapy for pts with acute stroke | IV-tPA (clot busting drug)
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| What is the protocol for giving tPA | initiated within 3 hours of sx onset (taken from the last time the pt was known to be sx free). Head CT without evidence of hemorrhage or other complicating lesion
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| What are pts treated with if they are not candidates for receiving tPA? | endovascular - catheter, remove clot mechanically
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| MERCI clot retriever | Used to remove clots
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| Acute stroke management | Temperature, Fluids/Glucose, BP, Antithrombotic agents
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| Cerebral Blood flow equation | MAP/CVR; if you stand, MAP decreases, so CVR accomodates this by decreasing/dilating in order to keep CBF constant.
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| In stroke patients, CVR is | constant. If MAP is decreased, then CBF decreases; there is some data to suggest that tx of antihypertensives in acute pts can be harmful. So don't treat high bp acutely
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| Only data available on anticoagulation in acute pts is on which drug | Aspirin (when started within 48 hours) decreases recurrent events up front. Need to treat 100 pts to decrease 1 stroke
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| 3 top complications in stroke patients | UTI (11%), CHF (10% - watch fluids!), Pneumonia (10%)
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| DVT prophylaxis | given to all stroke patients who can't get up and walk. DVT risk is 2%
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| Secondary Prevention | Platelet antiaggregants, anticoagulants, blood pressure, lipid lowering, endarterectomy
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| Prior stroke patients treated with Warfarin have what type of Risk Reduction? | 67% decrease in risk when treated with Warfarin
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| Each 10mmHg decrease in systolic BP is associated with _____% decrease in stroke risk? | 28%. Do not use acutely
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| Motor recovery after stroke is determined by | the severity of the stroke
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