Caitlin Whyte (Host): Welcome to Doc Talk, presented by Montefiore St. Luke's Cornwall. I'm Caiitlin Whyte. And with me today is Dr. Ahmad B. Hadid, an interventional cardiologist from Montefiore St. Luke's Cornwall. We will be discussing stroke awareness. To start us off, can you tell us about strokes?

Dr. Ahmad B. Hadid: It's a very important topic, talking about the awareness and educating general public about stroke. This comes from what we know that there is 800,000 people affected by stroke every year in the United States. That means there is a stroke happening every 45 seconds, a patient will experience a stroke. So, the importance of this topic is realizing what's the early sign, what's the symptoms of a stroke, to be aware of it as for medical care. And to realize something that I learned while back from the expert with the stroke, we have to look at the stroke as preventable, treatable, and beatable.

Host: Absolutely. So, what are some maybe symptoms or signs that we could see in another person or even notice in ourselves that would signify that a stroke is happening?

Dr. Ahmad B. Hadid: That's absolutely right. We should start from ourselves if you notice any unusual symptoms. And to make it easy for the public, the American Stroke Association and the American Heart Association made a very simple way of remembering these symptoms. It's called BEFAST. So, B stands for balance. Anybody who experiences a new onset of balance issues, unable to walk or imbalance, that could be a sign of stroke. E stands for eye problem. A new onset of double vision or losing vision in one eye or both eyes can indicate a stroke. F stands for face droop, which we know that part of the face can droop more than the other side. So if we ask the patient to smile, we will notice significant shift in the face. A stands for arm weakness. If we ask the patient to lift both arms, one arm will drift down because there is weakness in the arm. The S stands for speech difficulty, either the patient had difficulty finding the ward or a slurred speech or not able to read certain words. And the last letter is T, which stands for time to call for emergency, to call 911 if you identify any of those symptoms.

Host: Great. So Doctor, if we're noticing maybe some of that facial drooping or that vision loss, what do we do in the moment when we think a stroke may be happening?

Dr. Ahmad B. Hadid: The most important things in this situation is really to activate medical care and to call 911. There is a relatively short window from the time that these symptoms arise, where we can be able to provide certain medical treatment that can help to prevent the stroke from getting worse and the patient from having any further complication. So, calling 911 is really the best thing that we can do at the time. Stroke is a little bit different than heart attacks. We all hear about people who have a heart attack. And the first thing they will reach out to is an aspirin.

In somebody that we are concerned about the stroke, we should not administer any aspirin at all. We should just call 911 and ask for medical care. And the reason for that is there is two type of strokes. The most common type of a stroke, 85% of it comes from a what's called ischemic stroke, which will be a lack of blood coming to certain part of the brain that can come from buildup of plaque and cholesterol, or a clot that arise and block the artery, prevent the part of the brain from getting enough blood. However, 15% of the stroke, it comes from what's called hemorrhagic stroke, which is secondary to bleeding. The artery can burst, break either because of the weak tissue or because of significant blood thinner or because of what we call aneurysm. Those are the patients that definitely, they should not get any aspirin. And with any of the symptoms I mentioned earlier, these symptoms, we can see it in both ischemic and hemorrhagic stroke. That's why, by getting to the emergency room, being evaluated by medical personnel, getting a good history, excluding other reasons, and getting a very immediate special x-ray of the brain called the CAT scan, that will tell us exactly what type of a stroke and what the best treatment for it.

Host: And tell us what is tPA medication, what it is and about its time constraints, and why that's important.

Dr. Ahmad B. Hadid: So, that's what I mentioned. Time is brain. Every minute, it goes where the artery is blocked, and the brain or part of the brain is not getting enough blood. There is at least one to two million cells in the brain that can die. And the longer we wait, the more damage can happen in certain parts of the brain. And at one point, these can be irreversible. So if we arrive on time, the immediate treatment is to give what's called a strong clot-buster medication as long as there is no bleeding called the tPA, that's called the thrombolytic therapy. It's a strong blood thinner that can dissolve that clot and resume the blood flow into that artery. The window to get this medication is four and a half hours from the last time that the patient was seen well. That's how important to get immediate medical care.

The other type of a treatment for ischemic stroke, if we are out of this window and if we think that the stroke is in a bigger artery and involves a large part of the brain, is something called the thrombectomy, which is an invasive test. The same way a cardiologist does the cardiac catheterization to go up to the heart and find the blockage, it's a procedure performed by putting a catheter in one of the arteries, typically in the artery in the groin or the femoral artery under the x-ray; direct a catheter toward the brain, inject the dye, confirm exactly where's the blockage, and try to take that clot out. That's called the thrombectomy. And those two treatments are really very successful. And as long as they've done it quick, the patient will have excellent recovery.

Host: Well, now, that we know what to do when a stroke is happening, and that time is such an important asset when it comes to seeking help, what are some effective strategies for preventing strokes in general?

Dr. Ahmad B. Hadid: So, that's an excellent question. As I mentioned before, stroke is preventable. The key here is to act fast and prevent yourself from having a stroke. Anybody is at risk of stroke, and the way you prevent a stroke is by taking good care of yourself.

So, what's the risk factor for stroke to try to avoid it or treat it? The most common risk factor for stroke is the same as risk factor for heart attack. It's the same, the risk factor for hardening of the arteries. So specifically, high blood pressure, if a patient's blood pressure not well controlled for years, that will affect the lining of the artery, leads to buildup of plaque and blockages. And if it's happened in the brain, it'll lead to a stroke. Number two is high cholesterol. If the cholesterol is high and not treated, it'll lead to the same thing. Number three is diabetes. So by controlling the risk factors, high blood pressure, diabetes, cholesterol, we can decrease the risk of stroke.

Other risk factors, specifically, one of the highest risk factors is smoking. Definitely not smoking will help to prevent us from having stroke. Overweight, another risk factor, not eating a healthy diet, leading a not active life and not exercising. So, those are the risk factors. And controlling risk factors and modifying those risk factors will definitely decrease the chance of having a stroke.

Host: And to wrap up our conversation today, Doctor, can you tell us a bit about how stroke care is managed at Montefiore St. Luke's Cornwall?

Dr. Ahmad B. Hadid: Our hospital is designed as a stroke center, meaningly we have experience with treating those patient, when the patient showed up in the emergency room. As we say, time is brain. A specific code will be activated in the emergency room where all the personnel involved with the treatment, including the emergency room personnel, the neurologist, x-ray technician, the CAT scan technician will be all standby to perform urgent and emergent diagnostic testing and treatment.

The patient will be triaged very quick. He will get examined by the emergency room physician. The neurologist will be contacted. The patient will be evaluated by the neurologist. He will get emergency CAT scan of the brain. Confirm what kind of stroke it is. If it's ischemic stroke, we will move to give them the tPA, the thrombotic therapy. If there is any indication of a bleeding, obviously, here we will go with a different drug. If we are outside the window and we suspected a stroke into a big branch, the patient will be moved toward the thrombectomy. It will be performed at Montefiore Hospital.

If patient received the thrombolytic therapy in the emergency room, he will be admitted in the intensive care unit. Monitored closely in the first 24 hours with the team of professionals, including an intensivist, a neurologist, a medical doctor. He will get a cardiac telemetry, blood work in the morning. He will get a physical therapist, occupational therapist, and speech therapist for evaluation. Depending on the recovery will determine what's the need of the patient, and we move forward from there.

Host: Well, thank you for joining us, Doctor. That was Dr. Ahmad B. Hadid. For more information about cardiovascular care, visit montefioreslc.org. If you enjoyed this podcast, please share it on your social channels. And check out the entire podcast library for topics of interest to you, I'm Caitlin Whyte. And this is Doc Talk presented by Montefiore St. Luke's Cornwall. Thank you for listening.