CONDITIONS

TIA

What Is TIA

A transient ischemic attack, or TIA, is often called a “mini-stroke,” but it would perhaps be better characterized as a “warning stroke,”—a warning of possible future stroke that you should take very seriously. A stroke occurs when blood supply to part of the brain is interrupted or severely reduced, depriving brain tissue of oxygen and nutrients. Within minutes of blockage, brain cells begin to die, causing severe, lasting damage such as partial paralysis, loss of sensation, or inability to speak.  Blood supply can be limited secondary to a blockage of the blood vessels, which is referred to as an ischemic stroke, or secondary to a rupture or leak of a blood vessel, which is referred to as a hemorrhagic stroke. If symptoms of the stroke resolve within 24 hours, it is referred to as a transient ischemic attack (TIA). If symptoms persist more than 24 hours, it is diagnosed as a stroke. TIA is caused by a clot; the only difference between a stroke and TIA is that with TIA the blockage is transient, or temporary. In comparison to stroke, TIA symptoms occur rapidly and last a relatively short time. Most TIAs last less than five minutes; the average is about a minute. When a TIA is over, it usually causes no permanent injury to the brain.

Blood clots may develop for a number of reasons, some common reasons include:

More rare causes of blood clots include:

  • Head or neck injury
  • Tear in wall of blood vessel located in neck
  • Inflammation in blood vessels, from conditions like syphilis, tuberculosis, other inflammatory diseases
  • Clumps of tumor cells, bacteria, or air bubbles (this is referred to an embolism) that move through the bloodstream
  • Condition that cause blood cells to stick together, like polycythemia—having too many red blood cells, sickle cell disease, and others

After a TIA, up to 10 out of 100 people will have astroke in the next two days. And up to 17 out of 100 people will have a stroke within 90 days. And 1 in 3 people who experience TIA go on to have a stroke within a year of the TIA. The risk of stroke is highest in the first 30 days after a TIA. If you or someone you love experiences a TIA, you have a window of opportunity to act, and help keep a permanent stroke from happening. Call 911 or go to the emergency room at your local hospital if any symptoms of TIA or stroke are present! A neurologist can help identify why the TIA occurred and ensure that the proper treatment regimen is put in place—either medication or surgery—that can prevent a stroke from occurring.

A quick acronym to see if you or someone you know has had a stroke is FAST:

F—Face drooping

A—Arm weakness

S—Speech difficulty

T—Time to call 911

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Risk Factors For TIA

The following factors increase your risk of TIA and stroke:

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Diagnosing TIA

If you are having a TIA or stroke, you or a loved one must call 911 immediately. An emergency team needs to evaluate the type of stroke you’re having and the areas of your brain affected by the stroke. They will need to rule out other possible causes of your symptoms, such as a brain tumor or a drug reaction.

Your doctor may use several tests to determine your risk of stroke, including:

  • Physical examination. Your doctor will ask you or a family member what symptoms you’ve been having, when they started and what you were doing when they began. Your doctor then will evaluate whether these symptoms are still present, ask about your medications and possible head injuries, as well as your personal and family history of heart disease. Your doctor will also check your blood pressure and use a stethoscope to listen to your heart and to listen for a whooshing sound (bruit) over your neck (carotid) arteries, which may indicate atherosclerosis (a buildup of plaque in your arteries). Your doctor may also use an ophthalmoscope to check for signs of tiny cholesterol crystals or clots in the blood vessels at the back of your eyes.
  • Blood tests. You may have several blood tests, which tell your care team how fast your blood clots, whether your blood sugar is abnormally high or low, whether critical blood chemicals are out of balance, or whether you may have an infection. Care providers will manage your blood’s clotting time and levels of sugar and key chemicals as part of your stroke care.
  • Computerized tomography (CT) scan. This scan uses a series of X-rays from a variety of angles to create a detailed cross-sectional image of your brain.
  • Magnetic resonance imaging (MRI). This test uses powerful radio waves and magnets to get hundreds of images of your brain. Unlike a CT scan, an MRI doesn’t use radiation.
  • Carotid ultrasound. Sound waves create detailed images of the inside of the carotid arteries in your neck. This test shows buildup of fatty deposits (plaques) and blood flow in your carotid arteries.
  • Cerebral angiogram. Your doctor inserts a thin, flexible tube (catheter) through a small incision, usually in your groin, and guides it through your major arteries and into your carotid or vertebral artery. Then he or she injects a dye into your blood vessels to make them visible under X-ray imaging. This procedure gives a comprehensive view of arteries in your brain and neck.
  • Echocardiogram. An echocardiogram uses sound waves to create detailed images of your heart and can find a source of clots in your heart that may have traveled to your brain and caused your stroke.
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Symptoms of TIA

A TIA is a warning—it means you are likely to have a stroke in the future—or even the near future. 10% of all who have TIA experience a stroke within two days of the TIA. Call 911 immediately if you think that you or someone you know has had a TIA or stroke—early treatment can make all the difference. Symptoms of TIA typically occur suddenly and are always transient, or temporary; and go away within 10 to 20 minutes if not less.

Symptoms of TIA are just like symptoms of a stroke, and vary depending on what part of the brain is affected. These include:

  • Trouble with walking or balance. You may stumble or experience sudden dizziness, loss of balance or loss of coordination or altered consciousness.
  • Trouble with speaking and understanding simple statements. You may experience confusion, slur your words or have difficulty understanding speech.
  • Paralysis or numbness of the face, arm or leg. You may develop sudden numbness, weakness or paralysis in your face, arm or leg, especially on one side of your body. Try to raise both your arms over your head at the same time. If one arm begins to fall, you may be having a stroke. Similarly, one side of your mouth may droop when you try to smile.
  • Trouble with seeing in one or both eyes. You may suddenly have blurred or blackened vision in one, or both eyes, or you may see double.
  • Headache. A sudden, severe headache, which may be accompanied by vomiting, dizziness or altered consciousness, may indicate a stroke.
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Prognosis

A TIA is often a precursor to stroke—if medical attention is sought immediately after experiencing symptoms of TIA, then there is a much-improved chance of warding of stroke. Stroke is the fourth leading cause of death in the United States. Mortality rates are declining, however. Over 75% of patients survive a first stroke during the first year, and over half survive beyond 5 years.  If someone who has had a stroke gets treatment within 3- 4.5 hours from when stroke symptoms first started, rate of recovery are vastly improved.

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Life after TIA

Improving the overall health of your body and heart can help reduce your risk of future TIA and strokes.

The following are tips for a heart-healthy lifestyle:

  • Stop smoking. An estimated 20% of all deaths due to heart disease are directly linked to smoking.
  • Keep your blood pressure and cholesterol under control. People with high blood pressure and cholesterol are at an elevated risk for heart disease. About 50% of ischemic strokes (caused by a blockage of the artery to the brain) are caused by high blood pressure.
  • Manage your weight. About one in three American adults is obese (weighing at least 20 percent above the “suggested” weight for their height), which doubles their risk for coronary artery disease (CAD) at a given age.
  • Engage in regular cardiovascular exercise. Exercise helps the heart work more efficiently, reducing blood pressure, raising HDL cholesterol, decreasing the tendency of blood to form clots, moderating stress, helping the body use insulin, and helping people maintain a healthy weight. Sedentary people who begin a regular program of exercise reduce their risk of a heart attack by 35 to 55 percent. Low-intensity activities, such as gardening or walking, if done regularly and over the long term, can decrease the risk of heart attack. Speak with your doctor about the right routine for you.
  • If you have diabetes, keep your blood sugar levels under control. People with diabetes are twice as likely to have a heart attack or stroke.
  • Eat a healthy diet. Opt for high fiber foods such as fruits, vegetables, and whole grains, as well as omega-3 oils such as coldwater fish and salmon), and mono- and polyunsaturated fats. But limit saturated fats and avoid trans fats, often found in fried foods, processed foods, and commercial baked goods.
  • Limit salt. The American Heart Association recently reduced the amount of salt recommended for everyone to just 1,500 mg a day, which is about two-thirds of a teaspoon.
  • Control stress.
  • Tame alcohol intake. There’s a growing consensus that light to moderate alcohol consumption–that is, two drinks or less a day for a man, one drink for a woman (a drink is defined as 12 oz. of beer, 4 oz. of wine, or 1.5 oz. of 80-proof spirits) can help prevent heart attacks. However, drinking more than that can increase the risk of heart attack and stroke.
  • Educate yourself about your condition so that you can know as much as you can about heart disease. This will help ensure you are getting the best treatment available, as well as train you to recognize any potentially harmful side effects or disease progression.
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Screening

Most heart diseases and risk factors contributing to heart diseases are screened for at regular physicals. The American Heart Association stresses the importance of regular screening for cardiovascular disease. American heart association volunteer and director of William Beaumont Hospital in Royal Oak, Michigan, Barry A. Franklin, Ph. D., said on the matter, “Regular cardiovascular screening is important because it helps you detect risk factors in their earliest stages. This way, you can treat the risk factor with lifestyle changes and pharmacotherapies, if appropriate, before it ultimately leads to the development of cardiovascular disease.”

Your doctor will most likely check the following:

  • Blood pressure. High blood pressure is one of the most common precursors to cardiovascular disease. If it is found early, appropriate medications can help reduce the risk of cardiovascular disease due to high blood pressure
  • Body mass index (BMI). A BMI of 25 or above is considered to be overweight, and a BMI above 30 indicates obesity.
  • Waist circumference. A large waist circumference is indicative of fat accumulation around the midsection, which significantly raises an individual’s risk of heart disease.
  • Diet. Your doctor will most likely ask you about your diet. If your diet is high in red meats, fats, and processed foods, he or she will most likely recommend a change to include more whole grains, fatty fish, and vegetables. A diet high in red meat, fats, and processed foods can cause high cholesterol and eventually atherosclerosis (hardening of the arteries).
  • Exercise. Your doctor will ask about your exercise regimen and may suggest more or less activity based on the limitations of your heart and body.
  • Smoking and drug use. Your doctor will ask about smoking and drug use, which can add significantly to the risk of heart disease. If you do smoke or use drugs, your doctor will be able to help you find the right pathway to quit.
  • Heart rate/heartbeat. Your doctor will conduct a physical exam, listening to your heart beat and taking your heart rate. Some doctors may wish to perform a regular electrocardiogram (ECG), which can help detect irregularities in the heart’s electrical activity. ECGs are recommended

If your doctor suspects you have a heart disease after a thorough examination, he or she may conduct several diagnostic tests to arrive at a diagnosis.

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Prevention

Studies show that approximately 80% of strokes are preventable, given that preventative measures are taken early enough. You can help prevent a TIA or stroke if you take care to control key risk factors and treat other medical conditions that can contribute to stroke.

Taking steps towards a heart healthy lifestyle is critical—but it is within your power to take control of these lifestyle changes, and that can be empowering!

Preventative measures against stroke include:

  • Quit smoking. An estimated 20% of deaths due to heart disease in the United States are linked directly to smoking.
  • Treat any existing heart conditions. These include high cholesterol, hypertension, atrial fibrillation, and circulation issues. Untreated heart conditions greatly raise the risk of stroke.
  • Stay active. Exercise helps the heart work more efficiently, reducing blood pressure, raising HDL cholesterol, decreasing the tendency of blood to form clots, moderating stress, helping the body use insulin, and helping people maintain a healthy weight.
  • Maintain a healthy weight. About one in three American adults is obese (weighing at least 20 percent above the “suggested” weight for their height), which doubles their risk for CAD at a given age. Obesity also increases the risk for hypertension, and high blood cholesterol.
  • Eat heart healthy foods. Fruits, vegetables, high-fiber foods, foods that are low in saturated fat, sodium, trans fat, and cholesterol. Eat oily, omega-3 rich fish like salmon, mackerel, lake trout, herring, and sardines at least two to three times a week
  • Avoid or control diabetes. Type 2 diabetes (non-insulin-dependent), is an important risk factor for heart disease.  According to the American Heart Association, heart disease and stroke are the number one cause of death for patients with type 2 diabetes, and adults with type 2 diabetes are two to four times more likely to have heart disease than those who do not.
  • Consider a drink a day. There’s a growing consensus that light to moderate alcohol consumption–that is, two drinks or less a day for a man, one drink for a woman (a drink is defined as 12 oz. of beer, 4 oz. of wine, or 1.5 oz. of 80-proof spirits) can help prevent heart attacks. However, drinking more than that can increase the risk of heart attack and stroke.
  • Take low-dose aspirin. The recommended regimen–a baby aspirin (81 milligrams) daily or half a regular aspirin (160 milligrams) very other day–can lower the risk of heart attack by about one-third by reducing the ability of platelets in the blood to stick together and thus form a clot. Aspirin can have side effects and isn’t right for everyone, so consult with your doctor.
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Medication And Treatment

After you’ve suffered a TIA you’ll probably be prescribed several medications to help prevent blood clots that can cause another TIA or stroke. Aspirin is most often used to prevent TIAs and strokes.

The types of medicines that prevent clotting are:

Anticoagulant medicines, or blood thinners. These reduce the chance of your getting clots in your arteries. Some anticoagulants include:

  • Warfarin (Coumadin, Jantoven)
  • Dabigatran (Pradaxa)
  • Rivaroxaban (Xarelto)
  • Heparin

Side effects of anticoagulants include:

  • Nausea
  • Frequent nosebleeds
  • Headaches
  • Back pain
  • Easy bruising
  • Increased menstrual bleeding
  • Hair loss
  • Diarrhea

*** Because anticoagulants lengthened the time required to form a blood clot, patients taking anticoagulants are at a higher risk for excessive bleeding and hemorrhaging. Speak to your doctor about the risks and benefits of taking anticoagulants. It is especially important to take into consideration this potentially life threatening side effect.

Anti-platelet medicines, which prevent clotting by keeping platelets from sticking together. They include:

  • Clopidogrel (Plavix)
  • Prasugrel (Effient)
  • Ticagrelor (Brilinta).
  • Aspirin

Side effects of antiplatelet medications include:

  • Nausea
  • Diarrhea
  • Rash
  • Excessive bleeding

Cholesterol-lowering and blood pressure-lowering medicines are also used to prevent strokes.

Cholesterol-lowering drugs include:

  • Atorvastatin (Lipitor)
  • Fluvastatin (Lescol)
  • Pravastatin (Pravachol)
  • Rosuvastatin (Crestor)
  • Simvastatin (Zocor)
  • Advicor®** (lovastatin + niacin)
  • Caduet®** (atorvastatin + amlodipine)
  • Vytorin™** (simvastatin + ezetimibe).
  • Ezetimibe (Zetia®), which removes cholesterol from the intestines

Side effects of cholesterol-lowering drugs include:

  • Headache
  • Insomnia
  • Rash
  • Flushing of the skin
  • Constipation
  • Nausea
  • Abdominal cramping/gas
  • Vomiting
  • Dizziness
  • Drowsiness
  • Muscle weakness

Blood pressure medicines include:

Angiotensin II blockers (ARBs)

Side effects of ARBs include:

  • Dizziness
  • Headache
  • Drowsiness
  • Nausea
  • Vomiting
  • Diarrhea
  • Cough—ARBs cause cough less frequently than ACE inhibitors so ARBs are often used when ACE inhibitors have this side effect in patients
  • Elevated potassium levels
  • Low blood pressure
  • Muscle or bone pain
  • Rash

Angiotensin-converting enzyme (ACE) inhibitors

Side effects of ACE inhibitors include:

  • Dizziness
  • Headache
  • Drowsiness
  • Diarrhea
  • Low Blood Pressure
  • Weakness
  • Cough
  • Rash

Beta-blockers

Side effects of Beta-blockers include:

  • Insomnia and sleep problems
  • Cold hands and feet
  • Erection problems
  • Depression
  • Asthma-like symptoms

Calcium channel blockers

Side effects of calcium channel blockers include:

  • Constipation
  • Dizziness
  • Headache
  • Irregular or very rapid heartbeat (palpitations)
  • Swollen ankles

Diuretics

Side effects of diuretics include:

  • Frequent urination
  • Extreme tiredness
  • Arrhythmia
  • Muscle cramps or muscle weakness
  • Dizziness
  • Blurred vision
  • Dehydration
  • Loss of appetite or nausea
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Complementary and Alternative Treatment

Complementary and alternative treatments for stroke can help with symptoms, recovery, and prevention, but please be aware that none of these alternative, complementary therapies is a direct treatment for stroke that should take the place of medical therapy. Always check with your cardiologist or primary doctor before adding or changing your regimen for treating and preventing stroke.

Acupuncture. This ancient treatment has been used for centuries in Asian cultures. Tiny needles are inserted painlessly into specific points in the body to help ease pain and treat paralysis and other muscle problems affected by stroke. Acupuncture can help with difficulties with language, paralysis, muscular issues; and is part of stroke treatment in both Japan and China. A similar therapy is acupressure—a type of soft tissue massage. This uses the same points as acupuncture without involving needles.

Dietary Changes.  Unhealthy amounts of cholesterol can lead to blood clots and embolism, which can cause stroke. Dietary changes can help prevent TIA or stroke, and can also help you live more healthily when recovering from TIA or stroke. Here are some top tips:

  • Eat whole grains, green leafy vegetables, lots of fruit, lean protein, especially if plant-based or fish.
  • Avoid foods high in:
    • Cholesterol
    • Saturated fat
    • Sodium (which are harmful to your blood and blood vessels
    • Ditch the soda—diet and regular. New research has shown a significant link between drinking diet soda and a significantly increased risk of stroke and heart attack over those who drink no soda.

Massage therapy is used for many different conditions; with respect to stroke, it can help alleviate muscular problems by increasing blood flow to affected areas.  As well, massage can help by:

  • Lowering blood pressure
  • Easing stress and anxiety
  • Relaxing body and mind
  • Improving mood
  • Helps keep depression under control

Yoga and Tai chi. Yoga and tai chi promote wellness in a number of ways. Both practices promote smooth physical flowing movements and because the exercise has a meditative aspect to it, can help invigorate mental focus that may have been lost due to the stroke. Yoga is also a good option for a low-impact exercise program for continued wellness and can work preventively as well.

Aromatherapy.  Certain scents are known to help people relax and relieve pain. Rosemary, lavender, and peppermint are three scents that people who have had strokes use to help with pain, small research studies have shown that when used with acupressure massage, that effects are more impactful than when no aromatherapy is used.

Herbal medicine. Some herbs may help improve blood circulation in the brain and brain function. Some may help protect you against another stroke. Consult your doctor before using any herbs or nutritional supplements, as they may interfere with medication you are already taking. Research has not been conclusive regarding the use of herbal medicines for TIA or stroke. Some herbal medicines that merit deeper study include Ginkgo biloba, Mailuoning, Xuesetong, Ligustrazine, and Acanthopa

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Care Guide

Having a TIA can be difficult for you and your family, causing concern for whether a stroke may occur shortly thereafter, but there are things you can do to help keep yourself healthy:

  • If you smoke, quit. Tobacco has direct and damaging effects on the cardiovascular system.
  • Avoid salt. Sodium promotes fluid retention. Avoid high-sodium foods, heavily processed foods and unnecessary salt.
  • Don’t forget to take your prescribed medications. Wearing a watch with an alarm, setting your smart phone alert, or keeping a labeled pill box on your dining table are helpful methods to remember.
  • Check other meds for potential side effects and interactions. Over-the-counter NSAIDS, such as aspirin, Motrin (ibuprofen) and Aleve (Naproxen) may increase fluid retention. Tell your doctor about any remedies you are taking.
  • Control risk factors. Work with your doctor to address high blood pressure, diabetes and atherosclerosis or other heart problems.
  • Reduce stress. The hormones released by the body in response to stress, anxiety and depression make the body work harder. Practice relaxation techniques, volunteer, and seek positive social interactions. The relaxing breath exercise can improve the oxygenation of blood and take workload off the heart.
  • Be open with your family and friends about your condition and consider joining a support group or on-line forum.
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When To Contact A Doctor

You should not hesitate to call 911 if you are experiencing any of these symptoms that come on suddenly. You could be having a STROKE.

  • Numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
  • Vision changes.
  • Trouble speaking.
  • Confusion or trouble understanding simple statements.
  • Problems with walking or balance.
  • Severe headache that is different from past headaches.
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Questions For Your Doctor

In addition to your primary care physician, you may want to include an internist (specialist in internal medicine), a neurologist (nervous system specialist), a cardiologist (heart specialist) and/or a neurosurgeon (surgeon specializing in brain and spinal cord operations).

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Questions For A Doctor

You will probably have different questions to ask your doctor depending on your heart condition. Be open about all your concerns. If you’re having difficulty focusing, bring along a friend or family member. Below you’ll find general questions you might want to ask your doctor about heart disease as suggested by the American Heart Association.

QUESTIONS ABOUT MEDICATION

  • What is the name of the medicine?
  • Is this the brand or generic name?
  • What is the medicine supposed to do?
  • What happens if I miss a dose of my medicine?
  • How will I know that my medication is working?
  • What are the risks of taking this medication?
  • What are the risks of NOT taking this medication?

QUESTIONS ABOUT DIET

  • What kinds of foods should I eat?
  • What kinds of foods should I avoid?
  • Should I restrict my calories or fat intake to a certain level?
  • What are some cooking tips that I should follow?
  • What do I need to know about eating out?
  • Do I need to see a nutritionist or dietitian?
  • Are there any groups in the community that can help me with my nutrition goals?
  • How can I control the portions? How much salt may I eat?

QUESTIONS ABOUT EXERCISE

  • Can I exercise?
  • Can I play sports?
  • What are the best types of activities for me?
  • How much activity do I need?
  • Can I have sex?
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