2. Presented by… Erin Rindels, MSN, RN, CNRN, SCRN
Stroke Nurse Coordinator
University of Iowa Hospitals and Clinics

3. Have you ever noticed if your heart has missed a beat?
If you have, you may be experiencing an arrhythmia.
Atrial Fibrillation (A Fib) is the most common type of
arrhythmia
A Fib damages the heart’s electrical system, leading to increased risk for stroke, heart attack & heart failure.
A Fib is an independent risk factor for stroke, increasing risk five fold.
Most people have felt their heart race or skip a beat either with exercise or strong emotion. That type of arrhythmia is usually not cause for alarm. However arrhythmias that occur more often or accompany other heart problems may be more serious and should be discussed with your healthcare provider.
Did you know it is estimated that on average, every forty seconds someone in the United States has a stroke, every year 55,000 more women than men have a stroke and every three to four minutes someone dies of a stroke?(According to American Heart Association’s computation based on the National Heart, Lung and Blood Institutes research) A Fib alone, can increase the risk of stroke by five fold.
Atrial fibrillation (A-Fib), creates a disorganized electrical signal that causes a disturbance in the upper and lower chambers of the heart, preventing them from working together. With A Fib, instead of the body receiving a constant, regular amount of blood from the ventricles, it receives rapid, small amounts and occasional random, larger amounts, depending on how much blood has flowed from the atria to the ventricles with each beat. A-fib can affect both men and women, and is most common in older people.

4. A-Fib Risk Factors Advancing Age Heart Disease High Blood Pressure
Alcohol/
Drug Abuse
Family History
Congenital Heart Disorder
Diabetes
Smoking
Obesity
High Fat Diet
Certain Pre-scribed Med’s
Sedentary Life
Style
Your risk factors include:
Age. The older you are, the greater your risk.
Heart disease. If have been with heart disease, valve problems, Anyone with heart disease, including valve problems, history of heart attack and heart surgery, has an increased risk of atrial fibrillation.
High blood pressure. Having high blood pressure, especially if it's not well controlled with lifestyle changes or medications, can increase your risk of atrial fibrillation.
Other chronic conditions. People with thyroid problems, sleep apnea and other medical problems have an increased risk of atrial fibrillation.
Drinking alcohol. For some people, drinking alcohol can trigger an episode of atrial fibrillation. Binge drinking — having five drinks in two hours for men, or four drinks for women — may put you at higher risk.
Family history. An increased risk of atrial fibrillation runs in some families.
To reduce your risk of developing an arrhythmia/A Fib or to slow its progression. Do:
Drink plenty of water
Eat a heart-healthy diet
Eliminate unnecessary stress
Exercise regularly
Maintain a healthy weight
See your doctor regularly
Don't:
Smoke or expose yourself to second-hand smoke
Drink excessive amounts of alcohol, caffeine, or sugary drinks
Ignore your symptoms, which may signal heart problems
A Fib accounts for 15-20% of strokes in the U.S. totaling 105, ,000 strokes per year. (American Heart Association)
If you find yourself at risk, work with your doctor to control your condition and lower your risk for complications.

5. How is A-Fib Diagnosed? Cardiac Exam Holter Monitor Event Monitor
Echocardiogram
Transesophageal Echocardiogram
Blood Tests
The doctor will do a complete cardiac exam, listening to the rate and rhythm of your heartbeat and taking your
pulse and blood pressure reading. The doctor will likely check to see whether you have any sign of problems with
your heart muscle or valves. He or she will listen to your lungs to check for signs of heart failure.
An EKG is a simple test that detects and records the electrical activity of your heart. It is the most useful test for
diagnosing AF. It shows how fast the heart is beating and its rhythm (steady or irregular). It also records the timing
of the electrical signals as they pass through each part of the heart.
Holter Monitor- Also called an ambulatory EKG, this device records the electrical signals of the heart for a full 24- or
48-hour period. You wear small patches called electrodes on your chest that are connected by wires to a small,
portable recorder. The recorder can be clipped to a belt, kept in a pocket, or hung around your neck.
Event monitors are useful to diagnose AF that occurs only once in a while. The device is worn continuously, but only
records the heart’s electrical activity when you push a button. You push the button on the device when you feel
symptoms. Event monitors can be worn for 1 to 2 months, or as long as it takes to get a recording of the heart
when symptoms are occurring.
This test uses sound waves to create a moving picture of your heart. Anechocardiogram provides information about
the size and shape of your heart and how well your heart chambers and valves are functioning. The test also can
identify areas of poor blood flow to the heart, areas of heart muscle that aren’t contracting normally, and previous
injury to the heart muscle caused by poor blood flow.
A transesophageal (trans-e-SOF-ah-ge-al) echocardiogram, or TEE, takes pictures of the heart through your
esophagus (the tube leading from your mouth to your stomach). The atria are deep in the chest and often can’t be
seen very well on a regular echocardiogram. A doctor can see the atria much better with a TEE. In this test, the
transducer is attached to the end of a flexible tube that’s guided down your throat and into your esophagus. TEE is
usually done while the patient under some sedation. TEE is used to detect clots that may be developing in the atria
because of AF.
Blood tests. These tests check the level of thyroid hormone and the balance of your body’s electrolytes. Electrolytes
are minerals in your blood and body fluids that are essential for normal health and functioning of your body’s cells
and organs.
Once detected, there are 3 different types of A Fib:
Paroxysmal (par-ok-SIZ-mal) A Fib is the abnormal electric signals and rapid heart rate begin suddenly and then stop on their own. Symptoms can be mild or severe and last for seconds, minutes, hours, or days.
Persistent A Fib is a condition in which the abnormal heart rhythm continues until it’s stopped with treatment.
Permanent A Fib is a condition in which the normal heart rhythm can’t be restored with the usual treatments. Both paroxysmal and persistent A Fib may become more frequent and eventually result in permanent A Fib.

6. Start with Prevention!
It is never too late or too early to take control of your health
Below are some suggestions on how you can prevent A Fib and lead a healthy cardiovascular disease free life:
Not smoking
Regular physical activity
Maintaining a healthy weight
Limit alcohol intake
Control blood glucose
(especially if you have diabetes)
Regular check-up’s
Heart healthy diet filled with low saturated fatty food, low trans fat and low cholesterol
Specific treatments for A Fib include:
Blood Clot Prevention with use of warfarin (Coumadin), heparin and aspirin
Rate Control with use of beta blockers (ie: metoprolol and atenolol), calcium channel blockers (diltiazem and verapamil) and digitalis (digoxin)
Rhythm Control with use of amiodarone, sotalol, flecainide, propafenone, dofetilide, ibutilide, and other older medications such as quinidine, procainamide and disopyramide.
Medical Procedures used to treat A Fib:
Electrical Cardioversion
Radiofrequency ablation
Maze Procedure
If A Fib is detected, there are treatments such as medicines, medical procedures or simple lifestyle changes that may be taken. Partner with your provider to discuss the best option for your condition.
People who have A Fib can live normal, active lives!

7. Know your next steps Research your family history
Schedule a physical exam
Talk to your physician about your best option!

8. We want you to know and understand the three R’s of stroke:
Be Stroke Smart
Recognize—Stroke symptoms
Reduce—Stroke risk
Respond—At the first sign of stroke,
Call 911 immediately
We hope your participation in today’s presentation will support you in becoming more stroke smart.
We want you to know and understand the three R’s of stroke:
– Reduce risk
– Recognize stroke symptoms
– Respond by calling 9-1-1
© 2011 National Stroke Association

9. Stroke Facts
Stroke is the fourth leading cause of death in the United States
795,000 people in the U.S. suffer strokes each year
133,000 deaths in the U.S. each year
– From 1998 to 2008, the stroke death rate fell approximately 35 percent and number of deaths fell by 19 percent
7,000,000 stroke survivors
Stroke is a leading cause of death in the United States behind heart disease and all forms of cancer combined.
Approximately 795,000 people in the U.S. have a new or recurrent stroke each year.
Stroke kills approximately 133,000 Americans each year. From 1997 to 2007, the stroke death rate fell approximately 35 percent and actual number of stroke deaths fell by 18 percent.
There are more than 6 million stroke survivors living in the United States. Men make up about 2,500,000 of survivors and women make up 3,900,000. About one-third have mild impairments, another third are moderately impaired and the remainder are severely impaired.
References:
American Heart Association. Heart Disease and Stroke Statistics 2011 Update At-a-Glance. At:
© 2011 National Stroke Association

10. Stroke Facts A leading cause of adult disability
Up to 80 percent of all strokes are preventable through risk factor management
On average, someone suffers a stroke every
40 seconds in the United States
Stroke is a leading cause of serious, long-term adult disability. Over the course of a lifetime, four out of every five families in the United States will be touched by stroke.
Up to 80 percent of all strokes are preventable.
Every 40 seconds someone suffers a stroke, every four minutes someone dies from a stroke.
References:
American Heart Association. Heart Disease and Stroke Statistics 2010 Update At-a-Glance. At:
Gorelick PB. Stroke Prevention. Arch Neurol. 1995;52: At:
© 2011 National Stroke Association

11. Women & Stroke
Stroke kills more than twice as many American women every year as breast cancer
More women than men die from stroke and risk is higher for women due to higher life expectancy
Women suffer greater disability after stroke then men
Women ages 45 to 54 are experiencing a stroke surge, mainly due to increased risk factors and lack of prevention knowledge
Stroke kills more than twice as many American women every year as breast cancer.
Each year, about 55,000 more women than men experience a stroke.
More women than men die from stroke - accounting for more than 67 percent of all stroke deaths.
Overall lifetime risk of stroke is higher in women then men because life expectancy is higher. Also, women who have already suffered a stroke are significantly more at risk for a second stroke than men after two years.
Women suffer greater disability and functional outcomes because they are more likely to require institutionalized care than men, which adds to the economic burden of stroke.
Women ages 45 to 54 are experiencing a stroke surge, mainly due to increased risk factors and lack of prevention knowledge.
References:
American Heart Association. Heart Disease and Stroke Statistics 2010 Update At-a-Glance. At:
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. Centers for Disease Control and Prevention National Center for Health Statistics National Vital Statistics System. National Vital Statistics Report. Volume 57, Number 14. Deaths: Final Data for April 17, 2009.
Dearborn JL, McCullough LD. Perception of Risk and Knowledge of Risk Factors in Women at High Risk for Stroke. Stroke. 2009;40:
© 2011 National Stroke Association

12. Definition of Stroke Sudden brain damage
Lack of blood flow to the brain caused by a clot or rupture of a blood vessel
Ischemic = Clot
(makes up approximately
87 percent of all strokes)
Hemorrhagic = Bleed
- Bleeding around brain
- Bleeding into brain
Thrombotic
A stroke occurs when a blood clot blocks a blood vessel or artery, or when a blood vessel breaks, interrupting blood flow to an area of the brain. When a stroke occurs, it kills brain cells in the area surrounding where the clot or breakage occurrs.
There are 2 types of stroke:
1. Ischemic Strokes can occur two ways and are the most common, accounting for approximately 87 percent of strokes.
Embolic: Clot travels to the brain from another part of the body
Thrombotic: Clot develops in an artery
2. Hemorrhagic Stroke is a second type of stroke which occurs when a blood vessel in the brain breaks or ruptures. While hemorrhagic stroke is less common, it’s more deadly.
References:
American Heart Association. Heart Disease and Stroke Statistics 2010 Update At-a-Glance. At:
National Stroke Association. The Complete Guide to Stroke At:
© 2011 National Stroke Association

13. If you observe any of these symptoms,
Stroke Symptoms
Sudden and severe
headache
Trouble seeing
in one or both eyes
Sudden dizziness
Trouble walking
Sudden numbness
or weakness of
face, arm or leg
Sudden confusion
Trouble speaking
So how do you know if someone is having a stroke?
The most common stroke symptoms are:
Sudden numbness or weakness of face, arm or leg, especially on one side of the body
Sudden confusion, trouble speaking or understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination
Sudden severe headache with no known cause
If you see someone having these symptoms or experience any of these symptoms yourself, call immediately.
Appropriate treatment can be more effective if given quickly. Every minute matters!
References:
National Stroke Association. The Complete Guide to Stroke At:
If you observe any of these symptoms,
call immediately
Every minute matters!
© 2011 National Stroke Association

14. Stroke Strikes FAST You Should, Too. Call 9-1-1
F = FACE: Ask the person to smile.
A = ARM: Ask the person to raise both arms.
S = SPEECH: Ask the person to speak a simple sentence.
T = TIME: If you observe any of these signs, call immediately
One way to help remember the symptoms of stroke and what to do, is to learn the Face, Arms, Speech Test, otherwise knows as FAST:
F = FACE: ask the person to smile – do both sides of the face move equally? (Normal) Or does one side of the face not move at all? (Abnormal)
A = ARM: ask the person to raise both arms – do both arms move equally? (Normal) Or does one arm drift downward compared to the other? (Abnormal)
S = SPEECH: ask the person to speak a simple sentence – Does the person use correct words with no slurring? (Normal) Or do they slur their speech, use inappropriate words or is unable to speak at all? (Abnormal)
T = TIME: to call 911 – if you observe any of these symptoms, call 911 immediately. Every minute matters!
References: National Stroke Association. The Complete Guide to Stroke At:
© 2011 National Stroke Association

15. Perceptions of Stroke Reality :
Myth – Stroke:
Is not preventable
Cannot be treated
Only strikes the elderly
Happens in the heart
Recovery ends after 6 months
Reality :
Up to 80 percent of strokes are preventable
Stroke requires emergency treatment
Anyone can have a stroke
Stroke is a “Brain Attack”
Stroke recovery can last a lifetime
There are many misconceptions about stroke….
Myths vs. Realities:
Stroke is not preventable – up to 80 percent of strokes are preventable. We’ll discuss steps you can take to reduce stroke risk in a minute.
Stroke cannot be treated – Stroke can be treated, but requires emergency treatment. Call immediately if you experience or see someone with stroke symptoms.
Stroke only strikes the elderly – Anyone of any age can have a stroke.
Stroke is like a heart attack – Stroke is a “Brain Attack.”
Stroke recovery ends after 6 months – Stroke recovery can continue throughout a survivor’s life.
References:
National Stroke Association. The Complete Guide to Stroke At:
© 2011 National Stroke Association

16. Stroke Prevention Guidelines
Know your blood pressure. Have it checked at least annually. If it is elevated, work with your healthcare professional to control it.
Find out if you have atrial fibrillation (Afib) – a type of irregular heartbeat. If you have it, work with your healthcare professional to manage it.
If you smoke, stop.
1. Know your blood pressure. Have it checked at least annually. If it’s elevated, work with your healthcare professional to keep it under control. Having high blood pressure, or hypertension, increases stroke risk four to six times.
2. Find out if you have atrial fibrillation – a type of irregular heartbeat. If left untreated, Afib can increase stroke risk four to six times.
3. If you smoke, stop. Smoking doubles stroke risk.
References:
Gorelick PB, Sacco RL, et al. Prevention of a first stroke: a review of guidelines and a multidisciplinary consensus statement from the National Stroke Association. JAMA. 1999;281: At:
© 2011 National Stroke Association

17. Stroke Prevention Guidelines
4. If you drink alcohol, do so in moderation.
5. Know your cholesterol number. If it is high, work with your doctor to control it.
6. If you are diabetic, follow your doctor’s recommendations carefully to control your diabetes.
4. If you drink alcohol, do so in moderation. Recent studies have suggested that modest alcohol consumption (up to two glasses of wine or the alcohol equivalent) may reduce stroke risk. If you don’t drink, don’t start.
5. Find out if you have high cholesterol. High cholesterol can indirectly increase stroke risk by putting people at greater risk of heart disease. Talk to your doctor if your total cholesterol is higher than 200 mg/dL or if you LDL cholesterol is higher than 100 mg/dL.
6. If you are diabetic, follow you doctor’s recommendation carefully to control your diabetes. People with diabetes have a significantly higher stroke risk. This may be related to circulation problems that diabetes can cause.
References:
Gorelick PB, Sacco RL, et al. Prevention of a first stroke: a review of guidelines and a multidisciplinary consensus statement from the National Stroke Association. JAMA. 1999;281: At:
© 2011 National Stroke Association

18. Stroke Prevention Guidelines
7. Include exercise in your daily routine
8. Enjoy a lower sodium (salt) and lower fat diet
If you have circulation problems, work with your healthcare professional to improve your circulation.
If you experience any stroke symptoms, call immediately. Every minute matters!
7. Incorporate physical activity that you enjoy into your daily routine. Active people tend to have lower cholesterol levels. Regular exercise also seems to slow down or stop clogging of blood vessels.
8. Enjoy a low-sodium (salt) and low-fat diet. Too much salt may contribute to high blood pressure and make it more difficult to control. A diet that is low in fat will likely include vegetables, lean meats such as chicken and fish, low-fat dairy products and a limited number of eggs.
9. Ask your healthcare professional if you have circulation problems which increase your risk for stroke. If you do, work with your healthcare professional to control this condition.
10. If you experience any stroke symptoms, seek immediate medical attention by calling Every minute matters!
References:
Gorelick PB, Sacco RL, et al. Prevention of a first stroke: a review of guidelines and a multidisciplinary consensus statement from the National Stroke Association. JAMA. 1999;281: At:
© 2011 National Stroke Association

19. Stroke Awareness National Stroke Association
recommends that you learn stroke
symptoms and how to respond
by calling
© 2011 National Stroke Association

20. People Don’t Respond to Symptoms
Don’t recognize symptoms
Denial
Think nothing can be done
Worry about cost
Think symptoms will go away
Fear or don’t trust hospitals
Many people don’t recognize stroke symptoms. A 2001 National Stroke Association survey reported that many older Americans could not identify stroke symptoms. A 2009 study revealed that despite numerous national stroke public awareness campaigns, public knowledge of stroke symptoms and risk factors has not improved over the last 5 years.
People don’t want their fear of stroke to be confirmed. Stroke is one of the most terrifying medical emergencies because many people would rather die than be disabled. Yet quick confirmation of stroke is the best way to receive the treatments that are proven to greatly reduce disability after stroke.
Of those surveyed, only 40 percent would call immediately if they were having a stroke.
Many people worried about the cost of stroke treatment, especially if they do not have health insurance. Studies show that acute treatment is significantly less expensive than the costs of extensive rehabilitation and long-term care.
The survey also showed that two-thirds of respondents were unaware of the short time frame in which a person must seek treatment. Waiting to see if symptoms disappear can mean the difference between complete recovery and disability.
Fear of hospitals may keep some individuals from calling to get help when they experience stroke symptoms. Those who call immediately when experiencing stroke symptoms are likely to have a much shorter stay in the hospital than those who wait.
References:
National Stroke Association. Survivor Survey
Kleindorfer D, Khoury J, et al. Temporal Trends in Public Awareness of Stroke Warning Signs, Risk Factors, and Treatment. Stroke. 2009;40:
© 2011 National Stroke Association

21. For more information:
Visit to download the Don’t have a Stroke fact sheet.