The Importance of Acting F.A.S.T When Stroke is Suspected

Intro: MemorialCare Health System, excellence in healthcare, presents Weekly Dose of Wellness. Here is your host, Deborah Howell.

Deborah Howell (Host): Hey there and welcome to the show. I am Deborah Howell and today we'll be talking about the importance of acting fast when you suspect someone is having a stroke. Our guest today is Dr. Radoslav Raychev, Medical Director of the Stroke and Neurointerventional Program at MemorialCare Saddleback Medical Center. Welcome, Dr. Raychev.

Radoslav Raychev, MD: Hi, thank you very much for having me.

Deborah Howell (Host): Our pleasure. So first things first, what exactly is a stroke?

Radoslav Raychev, MD: Stroke essentially is a damage to the brain due to a brain vessel problem. Either a blockage of a brain vessel, which inability to deliver flow to important areas of the brain, which is the most common cause of stroke, or rupture of a brain vessel, which leads to bleeding in the brain, which is the less common type of stroke, but also very, very devastating. Stroke is very often easily recognizable because, as most of us know, the brain controls important function of the body including language, movement, sensation, vision, and walking. So whenever someone is having a stroke, there is loss of any of these important functions. For instance, one can all of a sudden lose speech or lose vision or lose ability to move one side of the body or lose sensation. The most important part of recognizing stroke is these symptoms happen very suddenly. They're not constant or gradual, they occur very suddenly as the name implies, a stroke, and that needs to, the patient needs to act very fast and we can talk about why that's important later.

Deborah Howell (Host): Okay, and probably the most important question I'm going to ask you is what is FAST?

Radoslav Raychev, MD: FAST is an acronym, FAST, that highlights the importance of acting fast and has four letters. Each one of them signifies something. So one of the most common signs of stroke is weakness in the face. So F stands for face. In other words, if your face is weak or droopy, that's what F stands for. The other common sign of stroke is losing ability of movement of the arm. So A stands for arm. In other words, if you have either facial droop or inability to move the face or inability to move the arm, those are the most common motor signs of stroke. S stands for speech. So that's another very common sign in which a patient loses ability to speak or understand. So S stands for speech. And T, the last letter, stands for time. Time to call 911.

Deborah Howell (Host): Got it. If everybody remembers FAST and what it means, we'll save a lot more lives. Are there any warning signs before a stroke happens?

Radoslav Raychev, MD: Yes, indeed. Every symptom that I just mentioned can happen and can go away. In other words, not all patients who experience these symptoms, these important loss of ability to do something, either see or speak or move one part of the body, quite often actually these symptoms can go away and the function of the body can resume. In other words, you lose speech and then you gain it back. And those are called TIA, transient ischemic attack. So that is a warning of a stroke. So in other words, if you have a stroke symptom that comes and then goes away, we shouldn't be reassured that we're doing great. Quite the opposite, that's a warning that another similar event can happen, and the second time it happens it can be actually permanent. And therefore the patient needs to really, really act fast and go to the nearest emergency room.

Deborah Howell (Host): And why is it so important to act fast when a stroke is suspected?

Radoslav Raychev, MD: Great question. So why is it important? Because stroke is very treatable. However, we have very, very limited time. So whenever there is a blockage of a brain vessel, which again is the most common type of stroke, we can unblock that vessel, but we have to do it only in a specific time window. Because every minute, whenever there is a blockage of a brain vessel and stroke is happening, every minute the brain loses cells. The brain cells start to die. And we have this rough estimate of 2 million brain cells dying every minute. So the longer you wait, the less likely we'll be able to treat the stroke and reverse the patient's deficit.

Deborah Howell (Host): I kind of remember it as time is brain.

Radoslav Raychev, MD: Yes, that's a very, very common acronym we use to highlight the importance of time. So time is brain, meaning time lost is brain lost. The sooner you come to the emergency room, the sooner we treat you, the more likely you will regain function and go back to normal.

Deborah Howell (Host): Dr. Raychev, can someone recognize when they're having a stroke themselves? And if they are and if they do realize they're probably having a stroke, what should they do?

Radoslav Raychev, MD: Great question again. Well, everything that I mentioned, all these symptoms, loss of ability to speak, to move, to feel, to walk, or to see, any of these symptoms are likely signs of stroke. And if the patient is by themselves and all of a sudden they cannot feel their arm, or they feel their face is drooping, or they feel like they lost sensation of one side of the body, or they cannot walk all of a sudden, the first thing is, first thing is to call 911. It's very important to call 911 instead of trying to get yourself to the emergency room, mostly because there is a very well established system of care that 911 not only will come faster than you driving yourself, but also will take you only to a place that is able to treat stroke. Not every hospital is able to treat stroke. And unfortunately, however, if the patient is by themselves and they have a loss of ability, they cannot speak for instance, that's a limitation obviously to call 911. In which case there are bracelets and other devices that can be used to activate 911.

Deborah Howell (Host): Okay, great. But definitely do not drive yourself, because you might drive yourself to a place that cannot help you.

Radoslav Raychev, MD: Exactly. Absolutely correct.

Deborah Howell (Host): And who is at risk for a stroke?

Radoslav Raychev, MD: Well, everybody who is older than 65 I would say is at risk for a stroke. But the most important stroke risk factors are high blood pressure. So that's perhaps the most common risk factor for stroke. So if we do treat blood pressure, we found that in the United States we can save approximately 300 to 400,000 patients from having a stroke if everyone who had blood pressure treated. Another important risk factor is diabetes. High cholesterol also is important. And a separate risk factor which is somewhat common in stroke is called atrial fibrillation, in which patients have an irregular heartbeat and tend to form clots in the heart. Those patients are at very high risk of stroke as well. And also, patients who have family history of stroke, those are obviously at a higher risk.

Deborah Howell (Host): Got it. Now let's talk about prevention. Are there ways to prevent stroke?

Radoslav Raychev, MD: Yes, of course. Just like I mentioned, if we monitor all these risk factors that I mentioned, so if patients go to their primary care doctors and monitor their cholesterol levels, their blood pressure, if they treat their blood pressure, they monitor their sugars and they treat diabetes as well. All these risk factors are, if they're well controlled, their risk of stroke significantly diminishes. If a patient is having atrial fibrillation, blood thinner is very important to take. And again, all this is in the hands of the primary care doctors and also in patients who know the risk factors and are aware to go to the doctor and stay on top of their health. For instance, if you have high blood pressure, it's very important to check your blood pressure daily by yourself, not only when you go to the doctor. Therefore you have a better idea how your blood pressure stands on a day-to-day basis. And of course, also watching your diet and exercising, those are very, very common ways of being healthy and prevent stroke, and not only stroke, but heart attack and all other diseases that can lead to increased cardiovascular risk factors.

Deborah Howell (Host): Now the good side. What are the potential treatments for stroke?

Radoslav Raychev, MD: First of all, not all strokes, but at least 80% of strokes can be prevented by the things that I mentioned. So we believe that if patients are really on top of their health, most strokes can be prevented, because the best stroke is the one that never happens. But when the stroke happens, like I said, if we act in time, if the patient comes to the proper place in time, we can reverse it. And we can treat it in such a way that most patients can come back to normal, even if they're paralyzed or cannot talk, we can reverse these deficits. And one of the most common ways to treat stroke is by giving a clot-busting medication which is called tPA, although this medication can be given only within the first three hours of stroke symptoms. And then we have advanced treatments, which are catheter-based, where we can introduce a catheter through the vessel in the groin vessel and push it all the way up to the brain vessels and remove the clot that's causing the stroke. And that treatment is called thrombectomy. And this is one of the most advanced and newest treatments of stroke, and we can treat stroke victims up to 24 hours with this methodology.

Deborah Howell (Host): That's pretty incredible. What is a stroke receiving center?

Radoslav Raychev, MD: Great question again. Stroke receiving center is a center that is capable of giving these therapies. Now, there is a primary stroke center, which can give the most common medication, tPA. And these centers are equipped with proper imaging and available specialists that can facilitate the treatment of giving the tPA. Or more advanced centers in which there's more advanced technology and more highly trained neurovascular specialists that can perform the procedure that I just described, a thrombectomy. So there are several tiers of complexity of stroke care, and that is recognized by the Joint Commission and other certifying body, by certifying centers either as primary or more advanced.

Deborah Howell (Host): Doctor, you answered this partially in that answer, but I do have a final question that I want to make sure everybody hears. What is a thrombectomy-capable stroke center?

Radoslav Raychev, MD: Yes, I did mention that in the previous answer, but it's important to highlight this. It is a center that can perform this procedure that I just described, thrombectomy. In other words, a center that is equipped with all necessary technology, imaging, and cath lab technology, specific also team that is trained to fast and efficient way bring the patient to the lab and perform this procedure called thrombectomy, and also monitor the patient post-procedure. And this is a fairly new level of certification, and it was released just this year. And there's only three centers in the country right now that are certified to be thrombectomy-ready, and there'll be many, many more. And luckily we are, Saddleback is one of them. And all this is in response to this newest evidence showing that thrombectomy indeed is a very important and life-saving, mostly brain-saving procedure. And another important factor is that patients go directly to these centers even if they don't need this procedure. In case they need it, it will be very important that they end up in a center like this, rather than going from one center to another and losing time. Because as we mentioned before, time lost is brain lost when stroke is happening.

Deborah Howell (Host): Wonderful. Once again, MemorialCare Saddleback Medical Center is a thrombectomy-capable stroke center, so just make note of that. We want to thank you so much, Dr. Raychev, for your time today. We really appreciate having you on the show.

Radoslav Raychev, MD: Oh, thank you. Thank you very much for having me. It was my pleasure.

Deborah Howell (Host): For more information or to listen to a podcast of this show, please go to MemorialCare.org. That's all for this time. I'm Deborah Howell. Thank you for listening and have yourself a great day.