Dr Lucio D’Anna is a Consultant Neurologist at the Department of Stroke & Neurosciences at Imperial College London NHS Trust. He is also Honorary Senior Lecturer at the Division of Brain Sciences, Imperial College London.
If a patient has suffered or is suffering a stroke, they may experience weakness or paralysis in an arm and or leg, difficulty speaking, lost vision in part of the visual field or complain of numbness and / or tingling down one side of the body.
Risk Assessment & Prevention
Patients with a history of stroke are at much higher risk of suffering a further stroke. Consequently reducing stroke risk following a stroke is a major goal. The management of treatable risk factors is important for reducing the risk of ischemic stroke.
The major modifiable risk factors for stroke are the following:
- Diabetes mellitus
- Physical inactivity
Important but un-modifiable risk factors for stroke include age, ethnicity, sex, family history, and genetics.
Atrial fibrillation (AF) is a heart rhythm disturbance that causes at least 20% of all ischemic strokes; these strokes have a higher mortality and are frequently more disabling compared to other etiologies. Ischemic strokes caused by AF can be effectively prevented by oral anticoagulation. However, because AF is often asymptomatic and only paroxysmally present, it can easily escape diagnosis. Reportedly, delayed detection of AF is common in patients with stroke.
What is atrial fibrillation (AF)?
Atrial fibrillation is the most common heart rhythm disturbance. There are 1.2 million people with AF in the UK and it is more common in older people. Atrial fibrillation makes your risk of a stroke five times higher. If you have this condition, it’s important that you get the right treatment – both to control it and to reduce your risk of stroke.
Why does AF increase your risk of stroke?
If your heartbeat is irregular and fast, your heart may not have a chance to relax and empty properly before filling up with blood again. Blood can collect inside the upper chamber of the left side of the heart, and this increases the risk of blood clots forming. If blood clots form in your heart, there is a risk they can travel in your bloodstream towards your brain. If a clot blocks one of the arteries leading to your brain, it could cause a stroke
What are the symptoms?
Palpitations (being aware of your heart beating fast), breathlessness, chest pain or fatigue are common symptoms of AF. However, some people do not have any symptoms at all and AF is often only diagnosed during a specialist medical check-up.
How is AF diagnosed?
There are several technologies available for AF detection after stroke. These technologies may vary significantly in their invasiveness and duration of monitoring. Non-invasive screening for AF is possible with Holter monitoring, wearable patches or belts.
At Dementech we have available the Stroke Risk Analysis (SRA) clinic. The SRA is a telemedicine service based on an automated software providing automated AF detection. The SRA has been demonstrated to be able to improve AF detection.
The SRA Holter can be released on request and after 24h, 48h or 7 days patients will come back at Dementech for the follow up. SRA data will be sent via a secure internet connection to the central SRAclinic server for analysis. The SRAclinic analysis report will be available within few minutes.
In the case of detected AF, the SRA service provides source ECG tracks for clinical confirmation of AF. In the presence of manifest AF on ECG data, SRA clinic has a 99% sensitivity and specificity compared to normal standard of care. In this case your Stroke physician will discuss with you the treatment options available.
In patients who have an acute stroke, it is recommended the admission in a Hyperacute Stroke Unit (HASU) which is a specialised unit committed to providing the most effective and successful forms of treatments. Following emergency treatment to prevent further damage, the secondary prevention is crucial.