Stroke

Question 1

Spot the symptoms of stroke FAST

What do each of the letters in “FAST” mean?

Answer 1

• Face drooping one side
• Arm weakness
• Speech Difficulty
• Time to call 995

Question 2

Symptoms of stroke, other than “FAST”

Answer 2

• Difficulty walking on one side (W)
• Mental retardation (E.g. understanding speech) (R)
• Loss of balance, incoordination (I)
• Severe headache (H)
• Double vision (V)

WHIRV

Question 3

Modifiable Risk factors of stroke

Answer 3

• Three highs
• Unhealthy lifestyle and diet
• Smoking and alcohol
• Obese
• Heart condition (E.g. AF)

Question 4

Non-modifiable risk factors of stroke

Answer 4

• Age: Increase age = increase risk
• Fam Hx
• Genetic conditions

Question 5

Briefly describe how does AF lead to stroke?

Answer 5

• With AF = normal heart rhythm
• Irregular heart rhythm causes clots to form in the atrium
• Clot can dislodge and travel to the brain (Thromboembolism)
• Clot cuts off blood supply to the brain
• Clots from heart to brain = Cardioembolic stroke

Question 6

Vital signs to assess for in stroke

Answer 6

ABC:

• Airway
• Breathing
• Circulation

Question 7

In the secondary prevention of stroke, what are the list of conditions that must be considered?

Answer 7

1. HTN
2. AF
3. DM
4. HLD
5. Physical Activities
6. Smoking
7. Physical activity
8. Others

HADSHOPP

Question 8

Mr PH’s blood pressure is more than 20/10 above target. What are the preferred drug classes to use to overcome his HTN?

Answer 8

ACEI/ARB + CCB

Question 9

Choice of anti-hypertensive agents

Answer 9

• BB
• ACEI (ARB only if patient cannot tolerate ACEI)

Both reduce mortality

Question 10

How is DM managed to prevent stroke?

Answer 10

Similar to normal DM, similar level as HLD

Question 11

What are the drug classes used to manage HLD, and has shown benefits in preventing stroke?

Answer 11

• Statins
• Ezetimibe
• PCSK9 inhibitors

Question 12

Drugs used as antithrombotics to prevent stroke

Answer 12

• Aspirin 100mg OD
• Anti-coagulants like Warfarin and NOACs

Alternative to aspirin: Clopidogrel 75mg OD

Question 13

Why is atorvastatin used in managing HLD to prevent stroke? State the dose

Answer 13

• Intense statin regime to reduce LDL has shown benefits in reducing the ris of stroke
• Dose: 40-80mg ON

Question 14

Purpose of H2RA or PPI in managing stroke?

Answer 14

• Gastroprotective: to prevent stomach bleeding that may be caused by Aspiriny congestion

Question 15

Purpose of Nitrates after an acute MI

Answer 15

• No Mortality Benefit
• Reduce pain and relieve symptoms of pulmonary congestion
• Decrease angina attacks