Stroke can happen at any age, even in infants. In fact, one-third of strokes happen to people under age 65.
Many of the risk factors for stroke can be changed. Smoking, obesity, heavy drinking, high blood pressure — all can play a role, as can conditions such as heart disease.
In this segment, Dr. Nicole Chiota-McCollum discusses why it is important for you to know the signs of a possible stroke, learn your risk factors and identify what you need to do if you suspect you or a loved one is having a stroke.
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Signs of Stroke: FAST (Face, Arm, Speech, Time to call 911)
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Learn more about Nicole Chiota-McCollum, MD
Nicole Chiota-McCollum, MD
Nicole Chiota-McCollum, MD was born and raised in Ocala, FL. In 2004, she graduated from Furman University located in Greenville, SC. There she double majored in biology and Spanish language and literature. In 2008, she graduated from Georgetown University School of Medicine.Learn more about Nicole Chiota-McCollum, MD
Transcription:
Signs of Stroke: FAST (Face, Arm, Speech, Time to call 911)
Melanie Cole (Host): Stroke can happen at any age. In fact, one-third of strokes happen to people under the age of 65. Many of the risk factors for stroke can be changed – smoking, obesity, heavy drinking, high blood pressure all can play a role as conditions such as heart disease. It’s important for you to know the signs of a possible stroke, learn your risk factors, and identify what you need to do if you suspect if you or a loved one is having a stroke. My guest today, is Dr. Nicole Chiota. She’s a neurologist at the UVA Health System. Welcome to the show, Dr. Chiota. Tell us about stroke. What exactly is a stroke?
Dr. Nicole Chiota (Guest): Thanks, Melanie, I’m happy to be here. Stroke is an interruption of the normal blood flow to the brain. That can actually come in two different forms. There's a type of stroke called a bleeding or hemorrhagic stroke, which is really the minority of stroke that we see – it only accounts for 10 to 15% of strokes. The much more common type of stroke that we see is what we call an ischemic stroke where there is a blood clot that interrupts the blood flow to the brain, depriving the brain tissue of the oxygen and sugar that it needs for normal function.
Melanie: What puts somebody at higher risk for having one of these strokes?
Dr. Chiota: You mentioned a bunch of the risk factors that we typically think of. The same risk factors that put people at risk of developing heart disease also apply to developing stroke. High blood pressure, smoking, diabetes, obesity, an irregular heart rhythm called atrial fibrillation -- which can also be associated with heart disease in general, is another major risk factor. When someone comes to us with stroke-like symptoms, the first thing that we want to do is identify if in fact there has been a stroke – either a bleeding or an ischemic stroke. Then the next course – or the next phase of care is really identifying what any particular individual’s risk factors are, and then trying to mitigate those risks – implementing prevention strategies to reduce their risk of having another event.
Melanie: Well, let’s talk about something pretty important because there is a moniker that people should know if they think that they or a loved one are having a stroke. Tell us what that is and why time is brain, and that is so important when a stroke might be occurring.
Dr. Chiota: You’re absolutely right. We have effective interventions for stroke, but they are only available to people within the first several hours of when symptoms start. Recognizing the signs of stroke, calling 9-1-1 and seeking attention as fast as possible is really the cornerstone of effective stroke care. Recognizing the signs of stroke means being aware, and there’s an acronym, FAST, F-A-S-T, that you can remember to help keep the signs and symptoms of a stroke on top of the mind if you will.
The F stands for facial droop. The A is for arm weakness. S is for speech difficulty. If you have any of those symptoms, the T stands for time to call 9-1-1. Face, arm, speech, time to call 9-1-1. There’s been a recent analysis of how sensitive those symptoms are to detect stroke, and what they actually found was that it’s very good. About 85% of stroke patients have one of those three symptoms. If you’re already familiar with the acronym FAST and you want to go to the next level of knowledge, you can add BEFAST to your awareness -- B meaning balance and E being eyesight symptoms. If you include those two symptoms, it actually increases your sensitivity to detect stroke up to 95%. Balance, eyesight, face, arm, and speech are symptoms you want to keep in mind, and if you have – if you or any of your loved ones have any problems in those arenas, you want to call 9-1-1 because we would want to evaluate urgently for stroke.
Melanie: Dr. Chiota, what is the importance of calling 9-1-1 as opposed to driving a loved one to the hospital? Are there certain things the EMS can do on the way to the hospital that make it that much more important?
Dr. Chiota: That is a great question, and the answer is yes. EMS, in our current system of care, pre-alerts the hospital that they are arriving – triaging the patient too -- so that a team is in place when that patient arrives for an expedited evaluation. Here at UVA, that means that the neurology stroke team is actually awaiting patients in the Emergency Department. We have the CT table cleared so that as soon the patient is deemed stable and safe to go to radiology; we can get that scan done as urgently as possible. We have pharmacy support ready in the event that we need to mix the clot-busting medicine called tPA and administer it as fast as possible.
In the future, we anticipate that there may be other opportunities for advanced evaluation of patients while they’re still in the field, either using telemedicine or even by phone with the EMS providers to make sure that the patient is being triaged to centers that can provide the right level of care for the presenting symptoms.
Melanie: Speak about what you do when you’re waiting there for this suspected stroke patient. You mentioned tPA and the clot-busting medication, so let listeners know what they can expect. What does that do?
Dr. Chiota: tPA, the clot-busting medication, is the only FDA-approved medication that we have to treat acute ischemic stroke – the type of stroke where there is a blood clot. We actually all make tPA. It’s an endogenous substance, so it circulates in our bloodstream, but when we have a patient that we suspect that there is an acute blood clot, we can give a super dose of tPA to help the body break down the clot. What that does is restore blood flow to the area of the brain that has been robbed, if you will, of adequate oxygen and sugar stores. The idea is to restore blood flow to the area at risk around that brain tissue that hasn’t been receiving enough blood flow.
In cases where we actually see the blood clot on vessel imaging, we can combine tPA with a procedure called thrombectomy. What happens with a thrombectomy is our interventional neuroradiologist or vascular neurosurgeons can actually place a catheter through the groin and snake that catheter up into the blood vessels of the brain and pull the clot out. There have been several studies in the past several years that the combination of tPA with that type of procedure actually dramatically increases the likelihood that someone will have a functional, independent neurologic recovery after a stroke compared with folks who receive only tPA alone or no intervention at all.
Melanie: What is life like for stroke recovery and rehabilitation, and does this put someone at risk for having a recurrent stroke?
Dr. Chiota: People who have had one stroke are at high risk for having a second. Even if you have stroke symptoms that resolve, which we would call a TIA or transient ischemic attack, that indicates to us that you are at high risk for having another event that could put you at risk for disability or even death. We take these events very seriously in trying to identify what any individual’s risk is, and therefore, direct our preventative strategies to that individual’s risk. For some, that means screening for that irregular heart rhythm called atrial fibrillation. We put patients who have atrial fibrillation on different medicines than those who do not to try to prevent stroke. Treating blood pressure, screening and treating for diabetes, smoking cessation, are things that we encourage in all of our patients who have had strokes of either the hemorrhagic or the ischemic type.
In terms of life after a stroke, the fortunate thing is that strokes do get better. It takes time, and it takes rehabilitation. Working with our colleagues in physical therapy, occupational, and speech therapy, and the physicians who oversee all those therapy programs – in physical medicine and rehab – is a key part of stroke care. Our goal in evaluating people acutely is to offer interventions that will decrease the likelihood that patients will experience disability. But as I said before, really knowing the signs of stroke, seeking emergent attention if you were to ever experience them, and then, engaging in healthy lifestyles and having your risk factors treated is really the key to preventing disability from stroke.
Melanie: Dr. Chiota, tell us about the Stroke Center at UVA Health Systems achieving the target Stroke Elite Plus Honor Roll, which is the higher honor role for stroke centers.
Dr. Chiota: Yes, thank you, Melanie. We are very proud of this distinction that we’ve recently received. What it basically means is that we provide the highest level of care for patients presenting with complex vascular neurology problems -- whether that be TIA, hemorrhage, subarachnoid hemorrhage, ischemic stroke. We offer a 24 hour, 7 days a week program with coverage from the moment the symptoms are identified in the field, and we’re pre-alerted, and our team is ready to greet people in the Emergency Department, through potentially intensive care and the interventions that we offer, and then all the way out into the outpatient setting where we have our outpatient clinic coordinators to ensure that the stroke care that we offer from stroke onset all the way through the rehabilitative process is as comprehensive as it can be.
Melanie: Wrap it up for us, with your best advice about stroke awareness, knowing your risk factors, and also knowing what to do if you suspect that you or a loved one is having a stroke.
Dr. Chiota: Awareness is key. Remember FAST – Face, Arm, Speech, Time to call 9-1-1. If you can remember BEFAST where Balance and Eyesight problems are also signs of stroke. Calling 9-1-1 to seek emergent care as soon as any of those symptoms are recognized in either yourself or a loved one is of paramount importance. And beyond that, knowing your risk factors, working with your primary care physician to make sure that your blood pressure, and your sugar, and your cholesterol are under control, engaging in a healthy lifestyle – all of those things are the way to prevent stroke and ensure a long, healthy, and functional neurologic existence [LAUGHTER].
Melanie: Thank you, so much, for being with us today, Dr. Chiota. It’s really important information for listeners to hear. If you’d like to assess your risk of stroke, you can go to uvahealth.com/services/stroke-center, that’s uvahealth.com/services/stroke-center. This is UVA Health Systems Radio, and I’m Melanie Cole. Thanks, so much, for listening.
Signs of Stroke: FAST (Face, Arm, Speech, Time to call 911)
Melanie Cole (Host): Stroke can happen at any age. In fact, one-third of strokes happen to people under the age of 65. Many of the risk factors for stroke can be changed – smoking, obesity, heavy drinking, high blood pressure all can play a role as conditions such as heart disease. It’s important for you to know the signs of a possible stroke, learn your risk factors, and identify what you need to do if you suspect if you or a loved one is having a stroke. My guest today, is Dr. Nicole Chiota. She’s a neurologist at the UVA Health System. Welcome to the show, Dr. Chiota. Tell us about stroke. What exactly is a stroke?
Dr. Nicole Chiota (Guest): Thanks, Melanie, I’m happy to be here. Stroke is an interruption of the normal blood flow to the brain. That can actually come in two different forms. There's a type of stroke called a bleeding or hemorrhagic stroke, which is really the minority of stroke that we see – it only accounts for 10 to 15% of strokes. The much more common type of stroke that we see is what we call an ischemic stroke where there is a blood clot that interrupts the blood flow to the brain, depriving the brain tissue of the oxygen and sugar that it needs for normal function.
Melanie: What puts somebody at higher risk for having one of these strokes?
Dr. Chiota: You mentioned a bunch of the risk factors that we typically think of. The same risk factors that put people at risk of developing heart disease also apply to developing stroke. High blood pressure, smoking, diabetes, obesity, an irregular heart rhythm called atrial fibrillation -- which can also be associated with heart disease in general, is another major risk factor. When someone comes to us with stroke-like symptoms, the first thing that we want to do is identify if in fact there has been a stroke – either a bleeding or an ischemic stroke. Then the next course – or the next phase of care is really identifying what any particular individual’s risk factors are, and then trying to mitigate those risks – implementing prevention strategies to reduce their risk of having another event.
Melanie: Well, let’s talk about something pretty important because there is a moniker that people should know if they think that they or a loved one are having a stroke. Tell us what that is and why time is brain, and that is so important when a stroke might be occurring.
Dr. Chiota: You’re absolutely right. We have effective interventions for stroke, but they are only available to people within the first several hours of when symptoms start. Recognizing the signs of stroke, calling 9-1-1 and seeking attention as fast as possible is really the cornerstone of effective stroke care. Recognizing the signs of stroke means being aware, and there’s an acronym, FAST, F-A-S-T, that you can remember to help keep the signs and symptoms of a stroke on top of the mind if you will.
The F stands for facial droop. The A is for arm weakness. S is for speech difficulty. If you have any of those symptoms, the T stands for time to call 9-1-1. Face, arm, speech, time to call 9-1-1. There’s been a recent analysis of how sensitive those symptoms are to detect stroke, and what they actually found was that it’s very good. About 85% of stroke patients have one of those three symptoms. If you’re already familiar with the acronym FAST and you want to go to the next level of knowledge, you can add BEFAST to your awareness -- B meaning balance and E being eyesight symptoms. If you include those two symptoms, it actually increases your sensitivity to detect stroke up to 95%. Balance, eyesight, face, arm, and speech are symptoms you want to keep in mind, and if you have – if you or any of your loved ones have any problems in those arenas, you want to call 9-1-1 because we would want to evaluate urgently for stroke.
Melanie: Dr. Chiota, what is the importance of calling 9-1-1 as opposed to driving a loved one to the hospital? Are there certain things the EMS can do on the way to the hospital that make it that much more important?
Dr. Chiota: That is a great question, and the answer is yes. EMS, in our current system of care, pre-alerts the hospital that they are arriving – triaging the patient too -- so that a team is in place when that patient arrives for an expedited evaluation. Here at UVA, that means that the neurology stroke team is actually awaiting patients in the Emergency Department. We have the CT table cleared so that as soon the patient is deemed stable and safe to go to radiology; we can get that scan done as urgently as possible. We have pharmacy support ready in the event that we need to mix the clot-busting medicine called tPA and administer it as fast as possible.
In the future, we anticipate that there may be other opportunities for advanced evaluation of patients while they’re still in the field, either using telemedicine or even by phone with the EMS providers to make sure that the patient is being triaged to centers that can provide the right level of care for the presenting symptoms.
Melanie: Speak about what you do when you’re waiting there for this suspected stroke patient. You mentioned tPA and the clot-busting medication, so let listeners know what they can expect. What does that do?
Dr. Chiota: tPA, the clot-busting medication, is the only FDA-approved medication that we have to treat acute ischemic stroke – the type of stroke where there is a blood clot. We actually all make tPA. It’s an endogenous substance, so it circulates in our bloodstream, but when we have a patient that we suspect that there is an acute blood clot, we can give a super dose of tPA to help the body break down the clot. What that does is restore blood flow to the area of the brain that has been robbed, if you will, of adequate oxygen and sugar stores. The idea is to restore blood flow to the area at risk around that brain tissue that hasn’t been receiving enough blood flow.
In cases where we actually see the blood clot on vessel imaging, we can combine tPA with a procedure called thrombectomy. What happens with a thrombectomy is our interventional neuroradiologist or vascular neurosurgeons can actually place a catheter through the groin and snake that catheter up into the blood vessels of the brain and pull the clot out. There have been several studies in the past several years that the combination of tPA with that type of procedure actually dramatically increases the likelihood that someone will have a functional, independent neurologic recovery after a stroke compared with folks who receive only tPA alone or no intervention at all.
Melanie: What is life like for stroke recovery and rehabilitation, and does this put someone at risk for having a recurrent stroke?
Dr. Chiota: People who have had one stroke are at high risk for having a second. Even if you have stroke symptoms that resolve, which we would call a TIA or transient ischemic attack, that indicates to us that you are at high risk for having another event that could put you at risk for disability or even death. We take these events very seriously in trying to identify what any individual’s risk is, and therefore, direct our preventative strategies to that individual’s risk. For some, that means screening for that irregular heart rhythm called atrial fibrillation. We put patients who have atrial fibrillation on different medicines than those who do not to try to prevent stroke. Treating blood pressure, screening and treating for diabetes, smoking cessation, are things that we encourage in all of our patients who have had strokes of either the hemorrhagic or the ischemic type.
In terms of life after a stroke, the fortunate thing is that strokes do get better. It takes time, and it takes rehabilitation. Working with our colleagues in physical therapy, occupational, and speech therapy, and the physicians who oversee all those therapy programs – in physical medicine and rehab – is a key part of stroke care. Our goal in evaluating people acutely is to offer interventions that will decrease the likelihood that patients will experience disability. But as I said before, really knowing the signs of stroke, seeking emergent attention if you were to ever experience them, and then, engaging in healthy lifestyles and having your risk factors treated is really the key to preventing disability from stroke.
Melanie: Dr. Chiota, tell us about the Stroke Center at UVA Health Systems achieving the target Stroke Elite Plus Honor Roll, which is the higher honor role for stroke centers.
Dr. Chiota: Yes, thank you, Melanie. We are very proud of this distinction that we’ve recently received. What it basically means is that we provide the highest level of care for patients presenting with complex vascular neurology problems -- whether that be TIA, hemorrhage, subarachnoid hemorrhage, ischemic stroke. We offer a 24 hour, 7 days a week program with coverage from the moment the symptoms are identified in the field, and we’re pre-alerted, and our team is ready to greet people in the Emergency Department, through potentially intensive care and the interventions that we offer, and then all the way out into the outpatient setting where we have our outpatient clinic coordinators to ensure that the stroke care that we offer from stroke onset all the way through the rehabilitative process is as comprehensive as it can be.
Melanie: Wrap it up for us, with your best advice about stroke awareness, knowing your risk factors, and also knowing what to do if you suspect that you or a loved one is having a stroke.
Dr. Chiota: Awareness is key. Remember FAST – Face, Arm, Speech, Time to call 9-1-1. If you can remember BEFAST where Balance and Eyesight problems are also signs of stroke. Calling 9-1-1 to seek emergent care as soon as any of those symptoms are recognized in either yourself or a loved one is of paramount importance. And beyond that, knowing your risk factors, working with your primary care physician to make sure that your blood pressure, and your sugar, and your cholesterol are under control, engaging in a healthy lifestyle – all of those things are the way to prevent stroke and ensure a long, healthy, and functional neurologic existence [LAUGHTER].
Melanie: Thank you, so much, for being with us today, Dr. Chiota. It’s really important information for listeners to hear. If you’d like to assess your risk of stroke, you can go to uvahealth.com/services/stroke-center, that’s uvahealth.com/services/stroke-center. This is UVA Health Systems Radio, and I’m Melanie Cole. Thanks, so much, for listening.