1. Stroke Recognition and Prevention
Vicki Fahey, RN, MSN

2. Be Stroke Smart The 3 R’s of Stroke: Reduce: stroke risk
Recognize: stroke symptoms
We hope your participation in today’s presentation will support you in becoming more Stroke Smart.
We want you to know and understand the 3 R’s of Stroke:
Reduce Risk
Recognize Stroke Symptoms
Respond by Calling 911
Stroke is the most preventable of all catastrophic medical conditions.
Respond: at the first sign of stroke,
Call 911 immediately! 2

3. Stroke Facts Fourth leading cause of death in the US
Third leading cause of death in women
Leading cause of adult disability
795,000 Americans suffer strokes each year
6,000,000 stroke survivors
Stroke is the third leading cause of death in the United States behind heart disease and all forms of cancer combined.
Approximately 795,000 Americans have a new or recurrent stroke each year.
Stroke kills approximately 144,000 Americans each year. From 1995 to 2005, the stroke death rate fell 29.7%
There are an nearly 6 million stroke survivors living in the United States. About one-third have mild impairments, another third are moderately impaired and the remainder are severely impaired.

4. Well-known Stroke Survivors
President Gerald Ford
Teddy Bruschi
Sharon Stone
Della Reese
Kirk Douglas
Roy Horn of Siegfried & Roy
Mary Kay Ash
Charles Schultz
Harry Caray
Charles Dickens
Ed Koch
Ted Williams
“Seeing” a disease in the news always brings greater attention to it. Prominent people who have experienced strokes include:
U.S. Presidents Gerald Ford, Thomas Jefferson, Woodrow Wilson, Warren G. Harding, Franklin Delano Roosevelt, Dwight Eisenhower, Richard Nixon
Super Bowl player Teddy Bruschi
Actors Sharon Stone, Della Reese, Kirk Douglas and Robert Guillaume
Entertainers Luther Vandross and Roy Horn of Siegfried & Roy
Cosmetics entrepreneur Mary Kay Ash
Comics artist Charles Schultz
Sports commentator Harry Caray
Novelist Charles Dickens
Former New York City Mayor Ed Koch
Major league baseball player Ted Williams

5. __________________ Explaining Stroke Stroke is a Brain Attack
Same degree of emergency as a heart attack
Call to action!
This presentation will help you understand more about stroke – its prevention, treatment and recovery. It will cover stroke risk factors, prevention measures, how to recognize the symptoms of stroke and how to respond.

6. Definition of Stroke
Sudden brain damage from lack of blood flow to the brain caused by a blockage or rupture of a blood vessel
Ischemic = Blockage
85% of all strokes
Embolic
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 occurs.
There are 2 types of stroke:
1. Ischemic Strokes can occur two ways and are the most common, accounting for approximately 80% 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.
Hemorrhagic = Bleed
Less common

7. Brain Attack! Stroke is a “Brain Attack.”
Stroke happens in the brain not the heart
Stroke is an emergency. Call 911 for emergency treatment.
The term “Brain Attack” is the most descriptive and realistic description of a stroke. It also provides a powerful call to action.
A brain attack should warrant the same degree of emergency care as a heart attack. After all, your brain is your mind and your body’s most vital and delicate organ.
Immediate response is crucial because every minute matters – from the time symptoms first become noticeable to the time treatment is received, more brain cells die. In other words TIME IS BRAIN. The best thing to do is to call 911 for immediate assistance.
Treatment is available and some options are most effective if administered within the first three hours after experiencing symptoms.
Your chances of walking out of the hospital with little to no disability are greatly improved if you receive appropriate treatments early.
Unfortunately, it takes the average American 12 to 24 hours to get to the hospital after experiencing the first stroke symptom. This is why it’s important that everyone learns how to RECOGNIZE stroke symptoms and how to RESPOND.

8. Stroke Symptoms Sudden weakness or numbness of the face, arm or leg
Trouble seeing in one or both eyes
Trouble speaking
Sudden, severe headache
Sudden confusion or dizziness
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 911 immediately.
Appropriate treatment can be more effective if given quickly. Every minute matters!

9. Transient Ischemic Attack (TIA) Mini-stroke
Warning sign of a stroke
Symptoms same as stroke symptoms
Symptoms resolve within minutes or hours
More than 1/3 of people will have a future stroke
TIAs  transient ischemic attacks, or mini-strokes  are a serious warning of an impending stroke.
TIA symptoms are the same as for stroke.
TIAs are brief episodes of stroke symptoms that resolve within minutes or hours, unlike stroke symptoms which can last longer.
More than 1/3 of all persons who experience a TIA will go on to have a full stroke.
> Within two days of a TIA, 5% of patients will have a stroke
> Within 90 days of a TIA, 11% will have a stroke
> Within one year, 14% will have a stroke
> Within two years, 20% will have a stroke
Management of TIAs focuses on preventing a future stroke.
Jill there are some stroke specialists who now say that TIAs lasting more than half hour are strokes and will show damage on the MRI scans. This may need to be considered here. Should we also encourage calling 911 here!?

10. Think FAST!
F = Face: ask the person to smile-does one side of the face droop or is it numb?
A = Arm: ask the person to raise both arms- does one arm drift down?
S = Speech: ask the person to repeat a simple sentence
T = Time: to call 911
One way to help remember the symptoms of stroke and what to do, is to apply a tool called 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!

11. Stroke Recognition
If you experience any stroke symptoms or witness anyone experiencing symptoms, call 911 immediately.

13. Why Acting Right Away is Critical
Every minute matters!
The sooner one is treated with lifesaving treatment, the better the outcome.
tPA, a clot-busting drug, may improve the chance of getting better, but only if one gets help right away.

14. Best way to treat a stroke is to prevent it
Best way to treat a stroke is to prevent it! Up to 80% of strokes may be prevented!
Many strokes are preventable if you pay attention to pre-existing medical conditions and control lifestyle factors such as diet and exercise.
Working with top stroke experts across the country, National Stroke Association developed the following stroke prevention guidelines. These guidelines are the first set of recommendations established by a national expert consensus on what the public can do to prevent the third leading cause of death in the United States. They are the gold standard used by health care providers in educating their patients about stroke prevention.
National Stroke Association developed
guidelines to help people reduce
their risk for stroke.

15. Stroke Prevention
Risk factors: Actions or conditions that may lead to a stroke
Uncontrollable risk factors: Cannot be changed
Controllable risk factors: Can be changed

16. Uncontrollable Risk Factors
Age: Risk increases as we age
Race: African Americans and Hispanics at greater risk
Heredity: Family history
History of a prior TIA/stroke
Fibromuscular dysplasia
Patent foramen ovale (hole in heart)

17. Controllable Risk Factors
High blood pressure Smoking Atrial fibrillation Diabetes High blood cholesterol Physical inactivity and obesity Excessive alcohol intake Depression Carotid artery disease

18. High Blood Pressure Increases risk 4-6 x
Know your blood pressure: 120/80 mmHg
If no symptoms, you do NOT know
you have it.
If you have high blood pressure
Control it
Check it regularly
1. Know your blood pressure. Have it checked at least annually. If it’s elevated, work with your doctor to keep it under control. Having high blood pressure, or hypertension, increases stroke risk four to six times.
Control your blood pressure with life style changes, such as eating less salt (DASH diet and exercising more) or medication may be necessary.

19. Salt restriction Weight loss Exercise Medication
High Blood Pressure
Salt restriction
Weight loss
Exercise
Medication

20. Smoking Increases risk 2x If you smoke, quit. Nicotine patch/gum
Support group
Smoking cessation program
3. If you smoke, stop. Smoking doubles stroke risk.

21. Atrial Fibrillation Increases risk 4-6 x
Atrial fibrillation - irregular heartbeat
If you have it, work with your doctor to manage it.
2. Find out if you have atrial fibrillation – a type of irregular heartbeat. If left untreated, AF can increase stroke risk four to six times. Should we talk about coumadin being the best treatment if there are no risk factors?

22. Diabetes
You may have no symptoms, so have blood sugar checked annually.
If you are diabetic, follow your doctor’s recommendations to control it.
People with diabetes have high blood sugar. You may not have symptoms, so have your blood sugar checked regularly. 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.

23. High Cholesterol Discuss the new guidelines with your doctor.
Know your cholesterol numbers.
Modify the numbers through diet
and/or medication.
When there is too much cholesterol in your blood, it can build up on the inside of your arteries and block blood flow to the brain. 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. You can control your cholesterol by diet and exercise, but you may need medication.
8. 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.

24. Cholesterol Profile Total Cholesterol Goal: < 200 mg/dL
Low Density Lipoprotein Cholesterol: < 100 mg/dL
High Density Lipoprotein Cholesterol: > 50 mg/dL
Triglycerides Goal: < 150 mg/dL

25. Bad Fats: Saturated and Trans Fats
Saturated Fats: Animal products (fatty meat, butter, eggs, cheese, palm oils, pork, skin from chicken, lard and whole milk products)
Trans Fats: Stick margarine, baked goods, fast food, cookies, crackers, frozen food
Use skim milk, mozzarella cheese.
Limit red meat.
Eat more fish and chicken

26. Sources of Good Fats Olive and canola oil Avocados Olives
Almonds, walnuts and other nuts
Salmon
Tuna
Mackerel

27. Food Label

28. Physical Inactivity Include exercise in your daily routine.
Physical inactivity affects
Blood pressure
Diabetes
Weight
Stress
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.
9. Ask your doctor if you have circulation problems which increase your risk for stroke. If you do, work with your doctor to control this condition.
10. If you experience any stroke symptoms, seek immediate medical attention by calling Every minute matters!

29. Physical Inactivity

30. Obesity Obesity leads to Hypertension Diabetes
Make healthy food choices and get plenty of exercise.
Eat fruit, vegetables, and whole grains to your diet.
Each week, aim to get 2.5 hours of moderate intensity aerobic physical activity.
Maintain a healthy weight by making healthy food choices.

31. Excessive Alcohol Intake
Excessive alcohol can increase blood pressure and triglycerides.
If you drink alcohol, do so in moderation.
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.

32. Depression Eat and smoke more Exercise less Increase blood pressure
Affect blood sugar
Discuss with your doctor.
Treatment may be recommended.

33. Stress
Healthy ways to cope with stress Talk to a friend Professional help Exercise Journal writing

34. Carotid Artery Disease

35. Carotid Artery Disease

36. Carotid Artery Disease
Carotid bruit
Get regular medical check ups
Carotid Artery Disease
Carotid bruit
Regular medical check ups

37. Peripheral Arterial Disease

38. Peripheral Arterial Disease
Predictor of stroke and heart attack.
Know if you have peripheral arterial disease.
Have the blood flow in your legs checked annually.
Women with PAD have an increased risk of death and disability from heart attack and stroke. 38

39. The Perceptions of Stroke
Myth
Stroke is not preventable
Stroke cannot be treated
Stroke only strikes the elderly
Stroke happens in the heart
Stroke 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 mis-conceptions about stroke….
Myths vs. Realities:
Stroke is not preventable – up to 80% 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 911 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. 39

40. Reasons People Do Not Seek Immediate Treatment
Do not 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.
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 911 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 911 to get help when they experience stroke symptoms. Those who call 911 immediately when experiencing stroke symptoms are likely to have a much shorter stay in the hospital than those who wait. 40

41. How can strokes be prevented?
Know the warning signs
Know your risk factors
Modify your risk factors
Obtain regular medical check ups
See immediate attention if you experience symptoms of a TIA or stroke

42. How can strokes be prevented?
Medication
High blood pressure
High cholesterol
Atrial fibrillation
Treatment of carotid artery disease

43. Carotid endarterectomy

44. Carotid stent

45. YOU Can Reduce the Impact of Stroke
Remember the 3 R’s of Stroke!
Reduce Risk
Recognize Stroke Symptoms
Respond immediately: Call 911
YOU can reduce the impact of stroke if you work to:
Reduce stroke risk: Follow the recommendations of National Stroke Association’s Stroke Prevention Guidelines.
Recognize stroke symptoms and Respond by calling 911 – ACT FAST!

46. Every minute matters!
ACT FAST