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TIA for the Patient

TIA for the Patient | Heart and Vascular Health | Scoop.it

The definition of TIA is changing. Previously, TIA was defined as a focal cerebral ischemic event with symptoms lasting < 24 hours. As computed tomography and magnetic resonance imaging have become more widely used, up to one-third of patients with TIA have radiological evidence of acute infarction. Therefore, the definition of TIA is moving from time-based to tissue-based, as “a transient episode of neurological dysfunction caused by central nervous system ischemia without acute infarction.” Unilateral weakness and speech disturbances are the most common manifestations of TIA. Unilateral weakness (face, arm, or leg) and speech disturbance (aphasia or dysarthria) are seen in approximately 31%-54% and 25%-42% of TIAs, respectively.

Short-term risk of stroke increases after TIA. The risk of stroke in the days and months after TIA can be estimated using the ABCD2 score.

Seth Bilazarian, MD's insight:

TIA, sometimes called by patients "mini-strokes" ,are often warning signs before a stroke.  Evaluating how much risk there is of a completed stroke with permanent disability can be estimated using the ABCD2 score pictured.  Converting the score to the risk as seen in the figure can help match the level of intensity by patients & doctors to evaluate and treat the TIA, with the goal of reducing the stroke risk.

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Stroke, an Animation & Telehealth ER evaluation

Stroke, an Animation & Telehealth ER evaluation | Heart and Vascular Health | Scoop.it
A description of what happens when a stroke occurs.
Seth Bilazarian, MD's insight:

Very good animation of the carotid artery and development of atherosclerosis and then thrombosis.  The feature following the animation is a real telehealth visit for a patient with a stroke in the setting of atrial fibrillation making a decision about whether to use thrombolytic treatment (tPA) for clot busting of the stroke causing clot.

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No clear answers on whether to close a "hole in the heart" (PFO) after a stroke

No clear answers on whether to close a "hole in the heart" (PFO) after a stroke | Heart and Vascular Health | Scoop.it

In approximately 30% of young survivors of stroke, no clear cause is identified despite a thorough evaluation. Patent foramen ovale ("hole in the heart") is found in about half of these patients, as compared with approximately 25% of the general population. Clinicians, then, often assume that the patent foramen ovale was the cause of the stroke, although it may be incidental in some patients. The most effective strategy for the prevention of stroke recurrence in such patients is uncertain, and some experts recommend closure of the patent foramen ovale to prevent future embolic events, although high-level data have been lacking.

Seth Bilazarian, MD's insight:

Key points

1.  Three trials: CLOSURE I, RESPECT  and PC Trial din not show a significantly lower rate of  stroke compared with medical therapy

2. Recurrent stroke rates in these trials were low in both mediacl and device arms and trended toward benefit of the device but did not reach stitistaical significance.

3.  These trials leave plenty for device skeptics and enthiuusiasts to continue to debate.

4. The device used in the RESPECT and PC Trial called Amplatzer had a good safety record.

5. RESPECT investigators are continuing to accrue data on the patients they enrolled and that other studies are ongoing.

6.  We are left for the moment to make decisions under conditions of uncertainty. Depending not only on the interpretation of the results, but also on the potential consequences of decisions.  The hard work of collaborative decision making between patients and the physicians that care for them will need to continue.

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It's official: New Oral Antithrombotic Agents in Nonvalvular AF now in guidelines

It's official: New Oral Antithrombotic Agents in Nonvalvular AF now in guidelines | Heart and Vascular Health | Scoop.it

The new oral anticoagulants (NOAC): dabigatran (Pradaxa) and rivaroxaban (Xarelto), both FDA approved, and apixaban (Eliquis), which has not been approved, can all be considered for stroke prevention in nonvalvular atrial fibrillation, a science advisory from AHA/ ASA stated.

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Warning Signs of a Stroke

Warning Signs of a Stroke | Heart and Vascular Health | Scoop.it
SIGNS AND SYMPTOMS OF A STROKE? When the brain does not get enough blood flow, many different signs and symptoms can occur. The amount and type of symptoms depend on what part of the brain is involved. Some of the common signs of stroke include 

Asymmetry in the face or a droop on one side of the face

Weakness on one side of the body (such as an arm, leg, or both)

Numbness or unusual sensations on one side of the body

Trouble speaking (speech is slurred; cannot repeat a simple phrase)

WHAT SHOULD I DO IF I NOTICE WARNING SIGNS? Time is the most important factor if you think you are having a stroke. The faster you can get to a hospital, the better your chances of recovery. Therefore, you should call the paramedics right away if you have any of the above warning signs—do not “wait it out” to see if the symptoms get better on their own. The reason that time is very important is that for some strokes, a medication that dissolves blood clots can be given through the bloodstream as treatment. This medication only works during the first few hours after a stroke. After that it is no longer effective and can even cause harmful side effects. Therefore, it is very important, when possible, to record the exact time that you or someone around you first noticed symptoms and the time that you were last well without symptoms. 
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What to Know – and Do! – About Stroke

What to Know – and Do! – About Stroke | Heart and Vascular Health | Scoop.it
A stroke, sometimes called a “brain attack,” occurs when blood flow to the brain is interrupted. When a stroke occurs, brain cells in the immediate area begin to die because they stop getting the oxygen and nutrients they need to function.
What are the symptoms of a stroke?—

The symptoms of stroke are distinctive because they happen quickly—thus the origin of the name "stroke."

Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body)Sudden confusion, trouble speaking, or understanding speechSudden trouble seeing in one or both eyesSudden trouble walking, dizziness, loss of balance or coordinationSudden severe headache with no known cause
Seth Bilazarian, MD's insight:

Good basic information from NIH MedlinePlus magazine everyone should know (called AHA "give me 5").  Knowing these stroke symptoms and seeking early treatment can be life saving.  Faster treatment reduces the likelihood and severity of disability after stroke.

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Melissa L Faraias's curator insight, December 15, 2014 10:24 PM

Some useful information about a stroke.

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Diagnosis of acute stroke by bad texting

Diagnosis of acute stroke by bad texting | Heart and Vascular Health | Scoop.it
Here's a new way to diagnose dyslexia by maladroit texting. New methods for #cHealth and #mHealth.
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New Blood Thinner: Xarelto for Atrial Fibrillation (AF) and Stroke Prevention

Xarelto (Rivaroxaban) is a new alternative for prevention of stroke for patients with atrial fibrillation. With its introduction, we now have the oldest option for patients, Coumadin (Warfarin) and another new anticoagulant treatment Pradaxa (Dabigatran) as options available to reuduce stroke (CVA) risk.  Drs Srivistava and Bilazarian discuss the newest entrant and review the data for patients on the series Matters of the Heart produced by Haverhill Community Television and Pentucket Cardiology.

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