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How to BE F.A.S.T. If Someone Is Having a Stroke
Dr. Daniel Landau discusses what a stroke is, how to recognize one as soon as possible and the quickest way to get treated.
Featured Speaker:
Daniel Landau, MD
Dr. Landau is a stroke neurologist at Capital Health, part of our Capital Institute for Neurosciences. He received his medical degree from New York University School of Medicine in New York, NY. He completed his residency in neurology at Montefiore Medical Center in Bronx, NY, where he also received his fellowship training in vascular neurology. Dr. Landau is a member of the American Academy of Neurology. Transcription:
How to BE F.A.S.T. If Someone Is Having a Stroke
Prakash Chandran: With strokes affecting between 23 and 29% of the population. It's important to know what to do. If you suspect you or a loved one is experiencing a stroke. The number one thing to remember is to remain calm, be fast, then immediately call 911. We're going to learn a little bit more about what that means today with Dr. Daniel Landau, a Neurologist at Capital Institute for Neuroscience. This is Capital Health Headlines, the podcast from Capitol Health, I'm Prakash Chandran. Dr. Landau, it's great to have you here today. What exactly is a stroke and why is it such a time sensitive disease?
Dr. Landau: So, a stroke is a sudden blockage of an artery to the brain, and that can be a very small stroke or can be very large stroke. And what happens is whatever part of the brain is affected, relates to a certain part of the body and your symptoms can vary widely based upon what part of the brain is affected. The reason why you have to act quickly is because every second that goes by every minute that goes by that you're losing blood and oxygen to vital parts of the brain. And if you don't restore that, then that part of the brain will become injured and die and it will lead to a permanent stroke. So if you catch it early enough, you can come to the hospital and we can try our best to fix that.
Host: And I want to expand on that a little bit more. You mentioned that it was a blockage of the artery, what actually causes this to begin with?
Dr. Landau: So, there are several different causes of stroke. There's a plaque that can build up over time, and that can cause a blockage of an artery. Plaque is a combination of cholesterol buildup and blood products. The other major thing that can cause a blockage is a large blood clot, which can occur in various settings. So it's either a blood clot or a plaque, and that will suddenly block off flow to that artery, subsequently leaving you without blood flow to a certain part of your brain.
Host: And one of the questions that I wanted to ask you is that I've always heard that you need to be fast to identify when you're having a stroke and what to do about it. So can you talk a little bit more about what that acronym means?
Dr. Landau: So, the acronym BE FAST represents different possible symptoms that one might have when they're having a stroke and each letter relates to a different symptom. So the B stands for balance. So if one is noticing, feeling that they're walking unsteadily, that they're off balance, that could be a sign of a stroke. The next letter E stands for eyes, and that can mean difficulty seeing out of one or both eyes. The F stands for face. And that is a drooping of one side of the face. The next letter is a, and that stands for arm, which is a sudden onset of weakness of one of your arms. The S is speech. And that can be slurring of your words or difficulty comprehending other people's words or difficulty producing words of your own. And then the T is the culmination of everything. If you notice any of these symptoms T stands for time and you want to call 911 as quickly as possible to try to restore the lack of blood flow to that region of the brain.
Host: Thanks for that explanation. Be fast. So let's say that you have a friend or a loved one that you see experiencing some of these symptoms. What should you do?
Dr. Landau: Yeah. The best thing to do is call 911, call the ambulance. Cause if there's a saying in medicine and neurology, that time is brain. So if you don't act quickly, you might be compromising a healthy brain. Call 911, get to a hospital because the treatment that is necessary can only be given by the hospital.
Host: Got it. And one of the things that I've heard before is that not all emergency departments are created equal. Some are more specialized in dealing with strokes versus others that aren't. Is there anything that people should be aware of when they do call 911?
Dr. Landau: Yeah. There's two main treatments in the acute phase of a stroke. One is a certain medicine that breaks up clot. The other one is a surgical procedure that physically removes the clot. More hospitals are capable of providing that medication. Fewer hospitals have the capability of a specialist to pull the clot out. But if the ambulance suspects you are having a stroke, they should definitely take you to a hospital that has the capability of providing this medication.
Host: Okay. Understood. I've also heard of a mobile stroke unit before. How does this cut down on the time to treatment?
Dr. Landau: The mobile stroke unit is a resource that some hospitals have, which we do at Capital Health. The way that this cuts down on time is that the ambulance is equipped with a CAT scan machine, as well as this particular medication that I briefly alluded to. It's called TPA. So what this mobile stroke unit will do, they'll call the neurologist on call. And if it looks like this is a stroke and the CAT scan does not rule out any contraindications for the medication, then we will give the medicine before they even arrive at the hospital. So depending on how far the ambulance is from the hospital, you could be saving 20, 30 minutes even more if it's in a more rural area. And as I said, time is brain. So each second you can cut down on the better chance of a successful recovery from the stroke.
Host: Yup. That totally makes sense to me. And that what a great resource you have there at Capitol. I wanted to talk a little bit about potential prevention. People know what it looks like or what they should do when it comes to things like heart health. They know that they should go get screenings for things like their heart, prostate cancer, breast cancer, but what can people do to potentially screen for the things that cause a stroke?
Dr. Landau: There's overlap in what puts you at risk for heart disease as what puts you at risk for stroke. So the best way to really screen and prevent a stroke is to regularly follow up with your primary care physician. Risk factors that are very pertinent towards stroke, include high blood pressure, diabetes, high cholesterol, and smoking, also any other potential heart conditions that can cause an arrhythmia of your heart. If all of these risk factors are checked routinely by your primary doctor, and you're on the appropriate medication to control these risk factors, these are the correct steps towards reducing your risk of a stroke. One other thing is also if smoking is another major risk factor for stroke, so trying to cut back or eliminate smoking, if that's something that someone does is another way to reduce stroke.
Host: I know that there is a misconception out there that strokes affect the elderly, but that's not necessarily true, is it?
Dr. Landau: That's correct. There is a higher percentage of people who are getting strokes that are elderly, but it can happen also to younger people. I've seen firsthand people in their twenties, thirties, and forties with strokes. Now it is less common, but it can happen. And oftentimes it can be related to risk factors that I mentioned previously, but sometimes there's lesser common things that can lead to a stroke that are not expected. So if any of these symptoms are happening and you are younger, there still is a possibility that it's a stroke, even if it's not as common as it is in the elderly
Host: And talking about some of the risk factors. And I kind of just want to move to prevention measures. My instinct is that people need to, if they're smoking to quit smoking to get on a better diet and to exercise in order to reduce some of the risk factors that you mentioned from having a stroke, is that correct?
Dr. Landau: Yes, that's correct. Yeah. I didn't mention it earlier, but diet and exercise are also key components to an overall healthy body lowering your risk of stroke and heart attack. So typically Mediterranean style diet is a good choice and also getting a regular level of exercise. And in terms of medications, the main ones would be medicines to control your blood pressure, medicines to control your diabetes, medicines that control your cholesterol. If you have any of these particular risk factors, a very commonly prescribed medication is a baby aspirin once a day.
Host: Oh, okay. A baby aspirin once a day. I had not heard that before.
Dr. Landau: It's not used if you don't have any risk factors, but if you develop over time, certain risks I mentioned above then if you can solve with your Doctor, that might be something that is recommended for you. And if you had a previous stroke, then aspirin is almost always indicated to prevent future stroke.
Host: So, I'd like to move to talking specifically about Capital Health. I know that they do a lot to help people that come in with strokes. Can you tell us a little bit more about how patients are treated when they come in?
Dr. Landau: When the patient comes to the hospital, they're going to be immediately triaged in the emergency room. There will be an overhead that will alert the hospital. That there's a potential stroke and immediately the patient will be addressed. They will get a CAT scan of their head. The reason this is done is to make sure there's no bleeding in the brain. And if the CAT scan does not show any active bleeding, then we could potentially provide a medication to break up a potential clot that's causing the stroke. Now there is a limitation with this medication it's called TPA. The other name for it is Alteplase. And the limitations of Alteplase are that you cannot give it if symptoms have been going on for longer than four and a half hours, there's other potential contraindications, basically anything that puts you at risk of bleeding. If you're on a medication that's a strong blood thinner. If you've had any recent surgeries or other complications that can cause bleeding, then you won't be eligible for this medicine.
So that's one potential treatment. If you arrive quickly and don't have any of these contraindications, the other potential treatment is a procedure that an endovascular surgeon can go in and go in through a catheter through an artery, either going through the groin or going through the wrist and feeding that catheter all the way to the arteries of the brain and can pull out that clot. And I've seen miraculous improvements of people's symptoms after this type of procedure, but again, not everyone is eligible for this procedure. You first need to have a large clot in a retrievable location, but the scans that are done the ER immediately will tell us whether that person is a candidate or not. So those are the two main treatments that can be done in the acute setting of a stroke at www.capitalneuro.org.
Host: So just as we close here, I see that you are a neurologist at the Capital Institute for Neurosciences. Where can people go to learn more?
Dr. Landau: They can go to our website at www.capitalneuro.org.
Host: Thank you so much, Dr. Landau. I truly appreciate you educating us today. That's Dr. Daniel Landau, a neurologist at Capital Institute for Neurosciences. Thanks for checking out this episode of Capital Health Headlines. For more information, you can go to capitalhealth.org or capitalneuro.org. To learn more about Capital Institute for Neurosciences, visit capitalneuro.org. And if you or a loved one is experiencing a stroke, call 911 immediately. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks, and we'll talk next time.
How to BE F.A.S.T. If Someone Is Having a Stroke
Prakash Chandran: With strokes affecting between 23 and 29% of the population. It's important to know what to do. If you suspect you or a loved one is experiencing a stroke. The number one thing to remember is to remain calm, be fast, then immediately call 911. We're going to learn a little bit more about what that means today with Dr. Daniel Landau, a Neurologist at Capital Institute for Neuroscience. This is Capital Health Headlines, the podcast from Capitol Health, I'm Prakash Chandran. Dr. Landau, it's great to have you here today. What exactly is a stroke and why is it such a time sensitive disease?
Dr. Landau: So, a stroke is a sudden blockage of an artery to the brain, and that can be a very small stroke or can be very large stroke. And what happens is whatever part of the brain is affected, relates to a certain part of the body and your symptoms can vary widely based upon what part of the brain is affected. The reason why you have to act quickly is because every second that goes by every minute that goes by that you're losing blood and oxygen to vital parts of the brain. And if you don't restore that, then that part of the brain will become injured and die and it will lead to a permanent stroke. So if you catch it early enough, you can come to the hospital and we can try our best to fix that.
Host: And I want to expand on that a little bit more. You mentioned that it was a blockage of the artery, what actually causes this to begin with?
Dr. Landau: So, there are several different causes of stroke. There's a plaque that can build up over time, and that can cause a blockage of an artery. Plaque is a combination of cholesterol buildup and blood products. The other major thing that can cause a blockage is a large blood clot, which can occur in various settings. So it's either a blood clot or a plaque, and that will suddenly block off flow to that artery, subsequently leaving you without blood flow to a certain part of your brain.
Host: And one of the questions that I wanted to ask you is that I've always heard that you need to be fast to identify when you're having a stroke and what to do about it. So can you talk a little bit more about what that acronym means?
Dr. Landau: So, the acronym BE FAST represents different possible symptoms that one might have when they're having a stroke and each letter relates to a different symptom. So the B stands for balance. So if one is noticing, feeling that they're walking unsteadily, that they're off balance, that could be a sign of a stroke. The next letter E stands for eyes, and that can mean difficulty seeing out of one or both eyes. The F stands for face. And that is a drooping of one side of the face. The next letter is a, and that stands for arm, which is a sudden onset of weakness of one of your arms. The S is speech. And that can be slurring of your words or difficulty comprehending other people's words or difficulty producing words of your own. And then the T is the culmination of everything. If you notice any of these symptoms T stands for time and you want to call 911 as quickly as possible to try to restore the lack of blood flow to that region of the brain.
Host: Thanks for that explanation. Be fast. So let's say that you have a friend or a loved one that you see experiencing some of these symptoms. What should you do?
Dr. Landau: Yeah. The best thing to do is call 911, call the ambulance. Cause if there's a saying in medicine and neurology, that time is brain. So if you don't act quickly, you might be compromising a healthy brain. Call 911, get to a hospital because the treatment that is necessary can only be given by the hospital.
Host: Got it. And one of the things that I've heard before is that not all emergency departments are created equal. Some are more specialized in dealing with strokes versus others that aren't. Is there anything that people should be aware of when they do call 911?
Dr. Landau: Yeah. There's two main treatments in the acute phase of a stroke. One is a certain medicine that breaks up clot. The other one is a surgical procedure that physically removes the clot. More hospitals are capable of providing that medication. Fewer hospitals have the capability of a specialist to pull the clot out. But if the ambulance suspects you are having a stroke, they should definitely take you to a hospital that has the capability of providing this medication.
Host: Okay. Understood. I've also heard of a mobile stroke unit before. How does this cut down on the time to treatment?
Dr. Landau: The mobile stroke unit is a resource that some hospitals have, which we do at Capital Health. The way that this cuts down on time is that the ambulance is equipped with a CAT scan machine, as well as this particular medication that I briefly alluded to. It's called TPA. So what this mobile stroke unit will do, they'll call the neurologist on call. And if it looks like this is a stroke and the CAT scan does not rule out any contraindications for the medication, then we will give the medicine before they even arrive at the hospital. So depending on how far the ambulance is from the hospital, you could be saving 20, 30 minutes even more if it's in a more rural area. And as I said, time is brain. So each second you can cut down on the better chance of a successful recovery from the stroke.
Host: Yup. That totally makes sense to me. And that what a great resource you have there at Capitol. I wanted to talk a little bit about potential prevention. People know what it looks like or what they should do when it comes to things like heart health. They know that they should go get screenings for things like their heart, prostate cancer, breast cancer, but what can people do to potentially screen for the things that cause a stroke?
Dr. Landau: There's overlap in what puts you at risk for heart disease as what puts you at risk for stroke. So the best way to really screen and prevent a stroke is to regularly follow up with your primary care physician. Risk factors that are very pertinent towards stroke, include high blood pressure, diabetes, high cholesterol, and smoking, also any other potential heart conditions that can cause an arrhythmia of your heart. If all of these risk factors are checked routinely by your primary doctor, and you're on the appropriate medication to control these risk factors, these are the correct steps towards reducing your risk of a stroke. One other thing is also if smoking is another major risk factor for stroke, so trying to cut back or eliminate smoking, if that's something that someone does is another way to reduce stroke.
Host: I know that there is a misconception out there that strokes affect the elderly, but that's not necessarily true, is it?
Dr. Landau: That's correct. There is a higher percentage of people who are getting strokes that are elderly, but it can happen also to younger people. I've seen firsthand people in their twenties, thirties, and forties with strokes. Now it is less common, but it can happen. And oftentimes it can be related to risk factors that I mentioned previously, but sometimes there's lesser common things that can lead to a stroke that are not expected. So if any of these symptoms are happening and you are younger, there still is a possibility that it's a stroke, even if it's not as common as it is in the elderly
Host: And talking about some of the risk factors. And I kind of just want to move to prevention measures. My instinct is that people need to, if they're smoking to quit smoking to get on a better diet and to exercise in order to reduce some of the risk factors that you mentioned from having a stroke, is that correct?
Dr. Landau: Yes, that's correct. Yeah. I didn't mention it earlier, but diet and exercise are also key components to an overall healthy body lowering your risk of stroke and heart attack. So typically Mediterranean style diet is a good choice and also getting a regular level of exercise. And in terms of medications, the main ones would be medicines to control your blood pressure, medicines to control your diabetes, medicines that control your cholesterol. If you have any of these particular risk factors, a very commonly prescribed medication is a baby aspirin once a day.
Host: Oh, okay. A baby aspirin once a day. I had not heard that before.
Dr. Landau: It's not used if you don't have any risk factors, but if you develop over time, certain risks I mentioned above then if you can solve with your Doctor, that might be something that is recommended for you. And if you had a previous stroke, then aspirin is almost always indicated to prevent future stroke.
Host: So, I'd like to move to talking specifically about Capital Health. I know that they do a lot to help people that come in with strokes. Can you tell us a little bit more about how patients are treated when they come in?
Dr. Landau: When the patient comes to the hospital, they're going to be immediately triaged in the emergency room. There will be an overhead that will alert the hospital. That there's a potential stroke and immediately the patient will be addressed. They will get a CAT scan of their head. The reason this is done is to make sure there's no bleeding in the brain. And if the CAT scan does not show any active bleeding, then we could potentially provide a medication to break up a potential clot that's causing the stroke. Now there is a limitation with this medication it's called TPA. The other name for it is Alteplase. And the limitations of Alteplase are that you cannot give it if symptoms have been going on for longer than four and a half hours, there's other potential contraindications, basically anything that puts you at risk of bleeding. If you're on a medication that's a strong blood thinner. If you've had any recent surgeries or other complications that can cause bleeding, then you won't be eligible for this medicine.
So that's one potential treatment. If you arrive quickly and don't have any of these contraindications, the other potential treatment is a procedure that an endovascular surgeon can go in and go in through a catheter through an artery, either going through the groin or going through the wrist and feeding that catheter all the way to the arteries of the brain and can pull out that clot. And I've seen miraculous improvements of people's symptoms after this type of procedure, but again, not everyone is eligible for this procedure. You first need to have a large clot in a retrievable location, but the scans that are done the ER immediately will tell us whether that person is a candidate or not. So those are the two main treatments that can be done in the acute setting of a stroke at www.capitalneuro.org.
Host: So just as we close here, I see that you are a neurologist at the Capital Institute for Neurosciences. Where can people go to learn more?
Dr. Landau: They can go to our website at www.capitalneuro.org.
Host: Thank you so much, Dr. Landau. I truly appreciate you educating us today. That's Dr. Daniel Landau, a neurologist at Capital Institute for Neurosciences. Thanks for checking out this episode of Capital Health Headlines. For more information, you can go to capitalhealth.org or capitalneuro.org. To learn more about Capital Institute for Neurosciences, visit capitalneuro.org. And if you or a loved one is experiencing a stroke, call 911 immediately. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks, and we'll talk next time.