- Stroke and Atrial Fibrillation
When I am at work, whether I am working in the intensive care unit or the emergency department, we have to be prepared for all types of emergencies. The 911- ambulance system has a way of communicating with the emergency department while in the field. That way, the emergency department can get prepared for the arrival of the patient. Patients arrive at the emergency department from a myriad of places such as from home, nursing homes, clinics, dialysis facilities, etc.
When a patient comes in with a sudden change in mental status, that is an emergency, and we need to scan the brain immediately. We need to ask questions such as:
- What was the patient doing?
- Has the patient been using drugs?
- How long has the pt had a change in mental status?
- What medications is the patient on?
- What is the patient’s previous medical history?
- Where did the patient come from?
When patients present with altered mental status, elevated blood pressure, irregular heartbeat, difficulty speaking, and motor weakness, the patient needs to be evaluated for a stroke. We see many patients with atrial fibrillation diagnosed with a stroke.
Why do Patients get a Stroke from Atrial Fibrillation (AFib)?
When you have atrial fibrillation, the normal rhythm of your heart becomes irregular, due to disorganized electrical signals in the atrium. This causes the upper chambers of your heart, called the atrium to beat irregularly. This restricts blood from being efficiently pumped from your atrium to your ventricles. When your heart can‘t pump out blood effectively, the blood can clot and go up to your brain. This is called an ischemic stroke.
How are Stroke Patients Diagnosed
Cat Scan is the gold standard diagnostic test in the initial presentation to the hospital. Many times the Ct scan is negative. A follow-up test is almost always done with an MRI /MRA.
If the CT scan is positive the patient will be considered for a clot-buster medication called Alteplase or tPA. However, there are some contraindications for when this medication can be given. If the patient is already taking a blood thinner such as Xarelto, Coumadin, or Eliquis, they cannot receive tPA. If the patient presents with very high blood pressure, they cannot receive tPA. A severe stroke, coma, or advanced age are contraindications to receiving tPA. Any recent hemorrhages, such as gastrointestinal bleeding are contraindications. If the brain accident occurred more than 4 hours, the patient cannot get tPA.
- It is important to note that when patients start taking these blood thinners, it is extremely important to continue taking them, and don’t stop without your doctor’s consent. Many of these drugs if suddenly stopped, will cause a stroke.
One of the main priorities is to figure out why the brain attack occurred. Patients will have a EKG, ECHO, or carotid duplex. The patient will most likely be admitted to the intensive care unit. If the brain attack is thought to be from atrial fibrillation, the patient will be started on a blood thinner if there are no contraindications. The patient will also be started on medications to control the heart rate and rhythm.
Physical rehabilitation will be started immediately while in the hospital as evidence shows that the quicker rehab is started, the better the outcomes. If someone is exhibiting signs or symptoms of stroke you should call 911 immediately.
Although patients should continue to take their prescribed medications, there are some natural things that will help.
- Evidence has shown that low magnesium contributes to stroke.
- Consumption of fish and fish oils has been shown to decrease stroke incidence.
- A low carb diet will reduce the incidence of stroke.
- A healthy weight and exercise will decrease incidences of stroke.