Cerebrovascular accident

By: Group 1

Cerebrovascular Accident“Brain Attack”

Brain attack

• Stroke is the loss or alteration of bodily function that results from an insufficient supply of blood to some parts of the brain . For human brain to function at peak levels, blood must flow through its many vessels. If the flow is obstructed to any part, the brain loses its energy supply and becomes injured, injury brain cells becomes permanent and tissues dies in the affected the region resulting in cerebral infarction.

• Stroke is one of the leading causes of disability. It can lead to weakness or paralysis usually of one side of the body.

Etiology and Causes

• Ischemic Stroke

Thrombotic

Embolic

Lacunar infarct

Transient ischemic attack

• Hemorrhagic Stroke

Intracerebral Hemorrhage

Subarchnoid Hemorrhage

Diagnostics

• Ischemic Stroke • Hemorrhagic Stoke

Thrombotic Stroke

• Occlusion of large cerebral vessel

• Older population

• Sleeping/resting

• Rapid event, but slow progression (usually reach max deficit in 3 days)

Embolic Stroke

• Embolus becomes lodged in vessel and causes occlusion

• Bifurcations are most common site

• Sudden onset with immediate deficits

• Embolysis

• Hemorrhagic Transformation

Lacunar Strokes - 20% of all stokes

• Minor deficits

• Paralysis and sensory loss

• Lacune

• Small, deep penetrating arteries

• High incidence:

• Chronic hypertension

• Elderly

• DIC

Transient Ischemic Attack

• Warning sign for stroke

• Brief localized ischemia

• Common manifestations:

• Contralateral numbness/

• weakness of hand, forearm, corner of mouth

• Aphasia

• Visual disturbances- blurring

• Deficits last less than 24 hours (usually less than 1 or 2 hrs)

• Can occur due to:

• Inflammatory artery disorders

• Sickle cell anemia

• Atherosclerotic changes

Hemorrhagic Stroke

• Rupture of vessel

• Sudden

• Active

• Fatal

• HTN

• Trauma

• Varied manifestations

Hemorrhagic Stroke

Intracerabral hemorrhage

Subarchnoid hemorrhage

PathophysiologyHemorrhagic Stroke

• Changes in vasculature

• Tear or rupture

• Hemorrhage

• Decreased perfusion

• Clotting

• Edema

• Increased intracranial pressure

• Cortical irritation

Vessels of the Brain

Vessels of the Brain

Circle of Willis

Risk FactorsNon modifiable• Age

• 2/3 over 65

• Gender

• M=F

• Female>fatality

• Race

• AA > hispanics, NA

• Asians > hem

• Heredity

• Family history

• Previous TIA/CVA

Modifiable • Hypertension

• Diabetes mellitus

• Heart disease

• A-fib

• Asymptomatic carotid stenosis

• Hyperlipidemia

• Obesity

• Oral contraceptive use

• Heavy alcohol use

• Physical inactivity

• Sickle cell disease

• Smoking

• Procedure precautions

Aneurysm

• Localized dilation of arterial lumen

• Degenerative vascular disease

• Bifurcations of circle of Willis

• 85% anterior

• 15% posterior

Stroke Symptoms include:

• SUDDEN numbness or weakness of face, arm or leg

• SUDDEN confusion, trouble speaking or understanding.

• SUDDEN trouble with vison.

• SUDDEN trouble walking, dizziness, loss of balance or coordination.

• SUDDEN severe headache

Hypertension

Hypertension

• Hypertension (HTN) or high blood pressure, sometimes called arterial hypertension, is a chronic medical condition in which the blood pressure in the arteries is elevated. Blood pressure is summarised by two measurements, systolic and diastolic, which depend on whether the heart muscle is contracting (systole) or relaxed between beats (diastole). This equals the maximum and minimum pressure, respectively. There are different definitions of the normal range of blood pressure. Generally, blood pressure at rest is considered normal when not higher than 120mmHg systolic (top reading) and 80mmHg diastolic (bottom reading)[1][2][3]. Hypertension is said to be present if it is often at or above 140/90 mmHg.

Etiology of Hypertension

• Systemic hypertension

• • long-lasting, usually permanent increase of systolic and diastolic blood pressure

• primary (essential) hypertension – unknown cause; usually coincidence of more factors – neural,

hormonal, kidney dysfunction, ...

• secondary (symptomatic) hypertension – symptom (sign) of other disease

Blood Pressure Ranges

• Normal blood pressure range < 120/80

• Pre-Hypertension >120/80 but <140/90

• Hypertension - >140/90

• Both systolic and diastolic pressures do not have to be out of range

• Only Systolic or Diastolic must be out of range to qualify as hypertension

Two Stages of Hypertension

•Stage 1 HTN >140/90 but <160/100

•Stage 2 HTN >160/100

Signs and Symptoms

• Known as the Silent killer

• If BP is very high, you may experience:

• -fatigue

• -decreased activity tolerance

• -dizziness

• -palpitations

• -angina

• -dyspnea

Complications Related to HTN

• Heart Failure

• Enlarged Left Side of the Heart

• Coronary Artery Disease

• Cerebrovascular disease (Brain)

• Peripheral Vascular Disease

• Kidney Failure

• Retinal Damage (Eyes)

How to Prevent HTN

• Lifestyle modifications prevent HTN and include:

• -Maintaining a Healthy Weight

• -Reduce Salt/Sodium Intake

• -Increase Physical Exercise

• Smoking Cessation

• Limit Alcohol Con

How to Prevent HTN

• Limit Fat Intake

• Control Diabetes

• Stress Relieving Techniques

• Take BP Meds as Ordered

• Home Monitoring of BP

Myocardial infarction

Myocardial infarction

• Myocardial infarction (MI; Latin: infarctus myocardii) or acute myocardial infarction (AMI) is the medical term for an event commonly known as a heart attack. An MI occurs when blood stops flowing properly to a part of the heart, and the heart muscle is injured because it is not receiving enough oxygen. Usually this is because one of the coronary arteries that supplies blood to the heart develops a blockage due to an unstable buildup of white blood cells, cholesterol and fat. The event is called "acute" if it is sudden and serious.

Myocardial infarction

• Etiology and pathophysiology

• Causes of reduced blood flow:

• Narrowing of a coronary artery owing to atherosclerosis

• A complete occlusion of an artery owing to embolus or a thrombus

• Myocardial necrosis caused by acute occlusion of a coronary artery due to plaque rupture or erosion with imposed thrombosis)

Clinical manifestations

• Pain is the cardinal symptom of an MI

• Anxiety and fear of impending death

• Nausea and vomiting

• Breathlessness

• Collapse/syncope

Diagnostic evaluation

• Electrocardiogram (ECG)

• Blood test (Cardiac enzymes)

• Echocardiogram

• Nuclear scan

• Chest radiographs

• Coronary angiography

• Exercise stress test.

• Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI).

Myocardial infarction (MI)

• Myocardial infarction (MI) is the irreversible necrosis of heart muscle secondary to prolonged ischemia. This usually results from an imbalance of oxygen supply and demand.

• A heart attack or acute myocardial infarction (MI) occurs when one of the arteries that supplies the heart muscle becomes blocked. Blockage may be caused by spasm of the artery or by atherosclerosis with acute clot formation. The blockage results in damaged tissue and a permanent loss of contraction of this portion of the heart muscle.

PATHOGENESIS:

• Occlusion is typically seen in the proximal 2 cm of the left anterior descending and left circumflex arteries and in the proximal and distal thirds of the right coronary artery.

• Rupture of the lipid-rich atheromatous plaque, intraplaque hemorrhage, and intraluminal thrombus are three pathological hallmarks most commonly recognized in the infarct-related coronary artery at the site of acute myocardial infarction.

PATHOGENESIS:

• Role of the platelet-derived mediators (e.g. TXA2, serotonin, ADP, & PDGF that promote thrombosis and vasoconstriction occur

• Diminished availability of those natural endogenous substances that inhibit platelet aggregation, such as EDRF, tissue plasminogen activator, and PGI2.

• Vasospasm is stimulated by mediators release from platelets.

PATHOGENESIS:

• Tissue factor activates the coagulation pathway.

• Thrombus occlude the lumen of vessel.

• Ischemia with out detection of coronary thrombosis due to vasculitis

Myocardial infarction

myocardial infarction (2) of the tip of the anterior

wall of the heart (an apical infarct) after

occlusion (1) of a branch of the left coronary

artery(LCA, right coronar

Get regular medical checkups.Control your blood pressure.Check your cholesterol.Don’t smoke.Exercise regularly.Maintain a healthy weight.Eat a heart-healthy diet.Manage stress.

Coronary artery disease

Coronary artery disease

• Heart disease is a result of plaque buildup in your coronary arteries -- a condition called atherosclerosis -- that leads to blockages. The arteries, which start out smooth and elastic, become narrow and rigid, restricting blood flow to the heart. The heart becomes starved of oxygen and the vital nutrients it needs to pump properly.

Symptoms • The most common symptom of coronary

artery disease is angina, or chest pain. Angina can be described as a heaviness, pressure, aching, burning, numbness, fullness, squeezing or painful feeling. It can be mistaken for indigestion or heartburn. Angina is usually felt in the chest, but may also be felt in the left shoulder, arms, neck, back, or jaw

Other symptoms that can occur with coronary artery disease include:

• Shortness of breath

• Palpitations (irregular heart beats, skipped beats, or a "flip-flop" feeling in your chest)

• A faster heartbeat

• Weakness or dizziness

• Nausea

• Sweating

How Does Coronary Artery Disease Develop?

• From a young age, cholesterol-laden plaque can start to deposit in the blood vessel walls. As you get older, the plaque burden builds up, inflaming the blood vessel walls and raising the risk of blood clots and heart attack. The plaques release chemicals that promote the process of healing but make the inner walls of the blood vessel sticky. Then, other substances, such as inflammatory cells, lipoproteins, and calcium that travel in your bloodstream start sticking to the inside of the vessel walls.

How Does Coronary Artery Disease Develop?

• Eventually, a narrowed coronary artery may develop new blood vessels that go around the blockage to get blood to the heart. However, during times of increased exertion or stress, the new arteries may not be able to supply enough oxygen-rich blood to the heart muscle.

• In some cases, a blood clot may totally block the blood supply to the heart muscle, causing heart attack. If a blood vessel to the brain is blocked, usually from a blood clot, an ischemic stroke can result. If a blood vessel within the brain bursts, most likely as a result of uncontrolled hypertension (high blood pressure), a hemorrhagic stroke can result.

What Is Ischemia?

• Cardiac ischemia occurs when plaque and fatty matter narrow the inside of an artery to a point where it cannot supply enough oxygen-rich blood to meet your heart's needs. Heart attack can occur - with or without chest pain and other symptoms.

• Ischemia is most commonly experienced during:

• Exercise or exertion

• Eating

• Excitement or stress

• Exposure to cold

• Coronary artery disease can progress to a point where ischemia occurs even at rest. And ichemia can occur without any warning signs in anyone with heart disease, although it is more common in people with diabetes.

Prevention

• Lifestyle changes

• Quit smoking. Avoid secondhand smoke too. Quitting smoking may be the best thing you can do to prevent heart disease.

• Exercise. There are lots of ways that exercise boosts your heart health. It can improve cholesterol and blood pressure. It can also help you reach a healthy weight. Talk to your doctor before starting an exercise program to make sure that it's safe for you.

• Eat a heart-healthy diet. The way you eat can help you control your cholesterol and blood pressure.

• Stay at a healthy weight. Being active and eating healthy foods can help you stay at a healthy weight or lose weight if you need to.

Prevention

• Medicines

• Control your cholesterol and blood pressure

• To reduce your risk of heart disease, you'll need to control your cholesterol and manage your blood pressure. Quitting smoking, changing the way you eat, and getting more exercise can help. But if these things don't work well enough, you may need to take medicines too.

References / sources

• http://www.slideshare.net/chevaz10/savedfiles

• http://en.wikipedia.org/wiki/Myocardial_infarction

• http://en.wikipedia.org/wiki/Hypertension

• http://en.wikipedia.org/wiki/Stroke

• http://www.webmd.com/heart-disease/guide/heart-disease-coronary-artery-disease