1. Jason C. Zydallis Raritan Valley Community College Nursing

2. What is a Stroke? o Interruption of blood flow to the brain resulting in tissue ischemia or death o Commonly known as a “Brain Attack” o Strokes are Medical Emergencies! o Brain cells begin to die from lack of oxygen o The extent of disability is dependent on the area of the brain involved. o Early Treatment is key to decreased disability

3. Stroke Statistics o Each year 700,000 Americans suffer a stroke o Stroke is the 3 rd leading cause of death among cancer and heart disease o Stroke accounts for more serious long term disabilities than any other disease o Highest risk after age 65, however, the risk of stroke doubles each decade after 55 o Stroke is more common in men especially African Americans.

4. Types of Strokes o Ischemic stroke – restriction of blood supply to the brain resulting in inadequate oxygen o Two types : Thrombotic and Embolic o Thrombotic strokes result from developing a clot usually due to vessel narrowing over time o Embolic strokes results when a piece of an existing clot breaks off and occludes a vessel o Ischemic strokes are the most common types of strokes o Hemorrhagic strokes are the second type of stroke and are caused by ruptures vessels inside the brain

5. Normal vs. Occluded Artery Ischemic Stroke Many factors lead to the occlusion of arteries such as high blood pressure, diabetes, smoking, and high cholesterol diets

6. Cerebral Hemorrhage (Bleeding) High blood pressure is #1 cause!!

7. Transient Ischemic Attack (TIA’s) o More commonly known as “Mini Strokes” o Are considered a warning sign of progressive cerebro-vascular disease (vessels of the brain) o Many only last up to an hour but can last for 24 hours

8. TIA Signs and Symptoms o Signs: Sudden severe headache with no known cause o Temporary loss of vision in one eye or double vision o Numbness or loss of sensation to one or both sides of the body o Inability to speak o Dizziness o Facial drooping o Difficulty walking o Difficulty swallowing o These are not normal occurrences. Seek Emergency Care! o If untreated symptoms may resolve, but can progress to a full blown stroke!

9. Nonmodifiable Risk Factors These are the factors that we have no control over but may increase the risk of stroke Age – Over 65 stroke increases Gender – Men have increased risk but women have an increased mortality rate Race – African Americans have increased risk Family History – Prior history of TIA’s or past strokes increases the risk for having another attack Important: Present any symptoms to your physician!

10. Modifiable Risk Factors o These factors are controllable and prevent the risk of stroke o High Blood Pressure – alone is the highest risk for stroke and is the least recognized (50% increase in risk) o Heart Disease – Atrial Fibrillation the most common arrhythmia and most treatable (20% increase in risk) o Diabetes - Increases the risk by 5 times the normal population for uncontrolled blood glucose o Smoking – Doubles the risk of having a stroke o Cholesterol – High fat diets increase narrowing of the arteries o Obesity – Increases blood pressure, fat molecules in the arteries, and high blood glucose o Sedentary Lifestyle – Lack of exercise

11. What do we do to decrease our risk? o Addressing our modifiable factors… o Consume a healthy diet with less fats and increased fruits and vegetables also decrease salt intake o Weight Control helps decrease risk for increased blood pressure o Blood Pressure Control – Check your blood pressure often and adhere to medicine regimen o Regular exercise – 30mins of walking 3 times per week has shown great benefit to cardiovascular health o Stop Smoking – Smoking both damages and constricts vessels in your body o Regular visits to your primary care provider to maintain best quality of health

12. What can medicine do for you? o Many advances in healthcare have been made which greatly increase our life expectancy o Here are some procedures that can decrease the risk of suffering a stroke o Carotid Endarterectomy – Surgical procedure to manually remove the build up of plaque inside of the carotid artery o Carotid Angioplasty – Same day procedure, vessels accessed through your groin and the artery is opened and stented to ensure positive blood flow o MERCI – mechanical removal of the clot o Anti-platelet drugs – Help decrease the occurrence of clots in high risk patients Ex: Aspirin, Plavix o Statins – Decreases the cholesterol levels in the blood which may decrease the buildup of additional plaques in the vessel Ex: Lipitor, Zocor, and Mevacor o TPA – Given for ischemic strokes only can be administered to help decrease effects of a stroke. Only given to those who meet strict criteria and requires inpatient monitoring in a medical facility o As you can see there are many options for care as well as following the guide to prevention of strokes

13. Lipids and Cholesterol Important to monitor cholesterol levels as well as the amount of fats in your diet LDL’s “Bad Cholesterol” should be lower than 100 mg/dl HDL’s “Good Cholesterol” should be greater than 40 mg/dl **If your doctor tells you that you have High Cholesterol ask for the results** Sample Lipid/Cholesterol Panel

14. Insulin Insulin control is very important to prevent damage to blood vessels Glucose monitoring should be implemented if you have diabetes and strict adherence is necessary General information about Glucose Levels and what they mean… Normal Target Fasting Blood Glucose for Non-Diabetics = 70-100 mg/dl and less than 130 mg/dl after meals Normal Target Fasting Blood Glucose level for Diabetics = 70-130 mg/dl and less than 180 mg/dl after meals

15. Blood Pressure Blood Pressure should be monitored regularly to ensure normal levels Levels should be checked by your MD every visit Monitors can be purchased for home usage Blood Pressure Interpretations 120/80 mmHg – Optimal 140/85 mmHg – Pre-Hypertension 150/90 mmHg – Stage 1 Hypertension 170/100 mmHg – Stage 2 Hypertension *Follow up with your PCP if you have episodes of “High” Blood Pressure*

16. Body Mass Index (BMI) A comparison of height and weight on a standardized scale Good = 19.5 – 25 Mild Obesity = 25-30 Obese = >30

17. Anabolic Steroids and Stimulants Increase Blood Pressure further increasing risk for stroke Increase the amount of cholesterol in the blood Increased fluid retention in the body increases blood pressure Stimulants increase pulse and metabolic rate causing adverse cardiac function Before starting any weight loss pills you should consult with your doctor because it may interfere with current health problems

18. Alcohol Use More than 2 drinks a day increase risk by 50% Most strokes occur within the first hour after alcohol consumption Affects the liver “thins the blood” causing increased hemorrhagic strokes. Increases the bad cholesterol in your blood resulting in plaque accumulation in the vessels

19. THE END Any questions or comments?