Lawrence Yerkes RE/MAX - Heart Health

Treating Stroke Systems as Seriously as One Would for a Heart Attack:
A “Brain Attack’s” Three Hour Window of Opportunity

When the telltale symptoms of a heart attack present themselves, few would think twice about seeking immediate diagnosis and treatment at the closest emergency room. Most people are aware of the seriousness of those symptoms—they have read about them, have had family or friends that have experienced them and their physicians may have warned them.

However, when the symptoms of stroke present themselves, there is often not the same level of urgency. Stroke's symptoms may be interpreted as the aches and pains of aging and often results in a nap or the setting of an appointment to visit the doctor in a week or two—hardly what one would do when presented with the signs of a heart attack. Perhaps, the word stroke itself contributes to the relative lack of urgency and should be replaced with a more compelling name such as “brain attack.”

If you felt sudden, crushing pain in your chest and had difficulty breathing, you’d probably know what it might be—a heart attack—and would also know that you should call 911 and get to an emergency room immediately. But what if you noticed that you were feeling a little numbness in your right arm, or felt just a little clumsier than usual while walking to work or climbing the stairs one day? Would you think you were having a stroke? Most people wouldn’t, and that’s the problem, say stroke experts. Although strokes are the third leading cause of death and the leading cause of disability in the United States, killing nearly 160,000 people every year (including twice as many women as breast cancer), the “brain attack” lags far behind the “heart attack” in public awareness of its causes, warning signs and consequences. In fact, one-third of all Americans over 50—the population most affected by strokes—don’t even know that strokes occur in the brain. But the damage to the brain caused by a stroke can often be uniquely far-reaching and debilitating.

A new study shows most Americans do not treat stroke as an emergency. When a stroke -- or brain attack -- first hits, many people don't even recognize the symptoms and do not immediately call 9-1-1. A new survey reports 1 in 3 Americans cannot name a single symptom a person might experience while having a stroke.

If you’re having a stroke, doctors say, “time lost is brain lost.” During an all-too-brief period of only one to three hours after symptoms first appear, aggressive and appropriate treatments can not only save your life, but also spare you from severe brain damage and permanent disability. “But because it doesn’t necessarily hurt to have a stroke, and the symptoms can often at first be easily dismissed—a little numbness or clumsiness—people don’t realize how urgent it is to seek treatment,” said Dr. James C. Grotta, a neurologist and director of the stroke program at the University of Texas Medical School in Houston.

Sudden Stroke Symptoms

ACT F/A/S/T

FACE: Ask the Person to Smile

If One Side Droops: ACT!

ARMS: Raise Both His/Her Arms

If One Arm Droops: ACT!

SPEECH: Repeat a Simple Sentence
Are the Words Slurred?

If Yes, ACT!

TIME: IF ANY SUCH SYMPTOMS ARE PRESENT, IMMEDIATELY CALL 911 OR GET TO THE NEAREST/BEST HOSPITAL AVAILABLE

The Brain Attack Coalition has several of the scales used by professionals to determine the severity of strokes as soon as they occur. They may be accessed by clicking on the Brain Attack Coalition link in the previous sentence.

It should be noted that women have additional unique stroke symptoms including:

sudden face and limb pain

sudden hiccups

sudden nausea

sudden general weakness

sudden check pain

sudden shortness of breath

sudden palpitations

More women die from strokes than from breast cancer. Also, African Americans are highly vulnerable to stroke.

Certain people—including smokers, diabetics, those with high blood pressure, and people with a family history—are at higher than normal risk of stroke, but anyone, at any age, can have one. But recognizing the signs of a stroke and calling for help are only half the battle. The other half is getting treated by the right doctors, at the right hospital. “Any intern, resident and medical student worth his salt knows the first five steps to take if someone presents having a heart attack, but the same isn’t true of stroke,” said Grotta. That’s partly because for many years, little could be done for stroke patients. “There was a longstanding sense of futility in the care of patients with stroke, but that needs to be gone, because we do now have interventions that make a difference,” said Dr. S. Claiborne Johnston, director of the stroke service at the University of California, San Francisco. “It used to be the same way with heart attacks: There were proven therapies that were underutilized. Now that problem is significantly lessened, and we need to do the same thing with stroke, because we have the ability to provide better acute care as well as doing secondary prevention.”

As Johnston noted, enormous strides have been made in stroke care in recent years, including the availability of tPA (tissue-plasminogen activator), a so-called "clotbuster" drug that, when administered during that magic three-hour window, can help dissolve clots, protect the brain, and reduce damage and disability.

This drug, however, must be administered with great care because it’s only appropriate for some patients and some kinds of stroke. For ischemic stroke—the most common kind, in which there are blockages in the brain’s blood vessels—tPA can be a life (and brain) saver. But with hemorrhagic stroke—a less common variety, which involves bleeding into the brain—tPA can increase that bleeding, with deadly results. Other patients at elevated risk of excessive bleeding also aren’t good candidates for tPA. Brain imaging, evaluated by a properly trained specialist, is essential before a patient receives tPA.

To improve stroke care around the country, the Joint Council on Accreditation of Healthcare Organizations (JCAHO) last year established a “primary stroke center” certification, which has already certified more than 150 primary stroke centers in 30 states, with more to follow. Several states, including New York, Florida and Massachusetts, have established their own stroke center programs (with required protocols that hospitals must adopt, similar to JCAHO’s), and other states may soon follow suit. In some areas, emergency service workers are required to take a suspected stroke patient to a certified stroke center, rather than simply to the nearest hospital. It should be noted that area hospitals might have the components and competency to be a primary stroke center, but have either not applied for JAHCO certification or may be currently under review and approval for same. It is advised that area hospitals be contacted in advance of such an emergency to determine their credentials in this regard. The JAHCO list below is current to June 10, 2006. The closest JAHCO certified primary stroke centers in the greater Delaware Valley are (click on hospital name to link to their center):

Abington Memorial Hospital, Abington, PA

Holy Redeemer Health System, Meadowbrook, PA

Deborah Shank (stroke contact)
Director of Quality Improvement
215-938-3202
dshank@holyredeemer.com

Hospital of the University of Pennsylvania, Philadelphia, PA

Lehigh Valley Hospital, Allentown, PA

Nazareth Hospital, Philadelphia, PA

Thomas Jefferson University Hospital, Philadelphia, PA

Virtua Memorial Hospital Burlington County, Mt. Holly, NJ

In addition to tPA, more new drugs and devices to treat acute stroke are on the horizon, underscoring the importance of early intervention. A corkscrew device, known as the Concentric Merci Retrieval System, has shown promise in early use since its approval by thee FDA last year, literally pulling clots from the brains of patients with particularly severe strokes. It's been very useful in opening up vessels and has improved outcomes in patients who would have had a horrible prognosis, said Johnston.

He noted that studies of a neuro-protective drug---aimed at preserving the brain that's at risk of dying from a clot, rather than breaking up the clot itself ---have also shown promise, with a second large trial due to show results in the spring of 2007.

"We have more encouraging results than we ever have had in the past," Johnston said. Acute care is becoming as important in stroke as it has been in heart attack.

Source: EldercareNetworkNews and includes information from an article by Gina Shaw for The Washington Diplomat.

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