Questions and Answers
What is the recommended LDL target level for stroke prevention?
Which medication is noted for reducing the incidence of stroke?
Which class of drugs is preferred for patients with atrial fibrillation to prevent stroke?
What should the target INR be for a patient on warfarin with a mechanical heart valve?
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Which statement about metformin in the context of stroke is correct?
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What lifestyle change is recommended for all current smokers to reduce stroke risk?
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In patients over 75 years old with clinical ASCVD, what intensity of statin therapy is appropriate?
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What is the role of plaque buildup in relation to thromboembolic phenomena?
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Which patient condition requires long-term anticoagulation therapy due to increased embolism risk?
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What is the advised alcohol consumption for men to minimize stroke risk?
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Study Notes
Stroke Management Guidelines
- NIHSS score greater than 6 indicates significant stroke severity.
- Persistent diastolic blood pressure (DBP) over 110 mmHg despite aggressive treatment may complicate management.
- Alberta Stroke Program Early CT score exceeding 6 represents increased risk and may guide treatment decisions.
Contraindications for Certain Treatments
- Mild ischemic stroke syndrome may lead to alternative strategies for management.
- Conditions such as intracranial vascular malformations, cerebral microbleeds, and extra-axial neoplasms pose relative contraindications for treatments.
- Recent seizures at symptom onset are critical considerations in treatment planning.
- Unruptured and unsecured intracranial aneurysms require careful monitoring, particularly if they arise due to rise in mean arterial pressure (MAP).
Mechanical Thrombectomy
- Recommended for select patients with acute ischemic stroke occurring within a 6-16 hour window.
- Focus on reduction of blood pressure is prioritized over the choice of antihypertensive agents.
- Patients can receive treatments like groin puncture if they exhibit large-vessel occlusions in anterior circulation.
Pharmacologic Management
- Common drugs used include Metformin (reduces stroke incidence) and Pioglitazone (lowers MI, stroke, death).
- Aspirin recommended for patients with atherosclerosis to decrease recurrent events.
- Statin therapy advised for primary prevention and to manage dyslipidemia in patients under 75 with ASCVD (high-intensity) and over 75 (moderate or high intensity).
Atrial Fibrillation Considerations
- Individuals with AF face a 4-5 times higher stroke risk; anticoagulation recommended if CHA2DS2-VASc score is 1 or higher (not solely based on female gender).
- Warfarin is the preferred drug for patients with mechanical valve replacements and those with ischemic heart disease.
- Target INR for patients with mechanical heart valves typically set between 2.0-3.0 for effective management, lasting up to one year.
Additional Risk Factors
- Lifestyle changes advised include smoking cessation, moderation of alcohol intake, and weight management.
- Strict dietary controls suggested, such as limiting sodium to reduce stroke risk.
Heart Valve Considerations
- Mitral valve prolapse increases thromboembolic risk, necessitating consideration for antithrombotic therapy.
- Anticoagulation necessary for patients with rheumatic heart disease to minimize recurrent embolism.
Nutritional Guidelines
- Limiting sodium intake is emphasized in dietary interventions to support cardiovascular health.
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Description
This quiz covers critical information regarding stroke management guidelines, contraindications for various treatments, and the application of mechanical thrombectomy. Test your knowledge on the NIHSS score, diastolic blood pressure considerations, and treatment protocols for acute ischemic strokes.
