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One of the most complex situations that a nursing professional face is the one where there is a probability of secondary stroke. That is why students like you are given the assignments discussing the methods of prevention, the medications and risks associated with secondary stroke.

Ischemic stroke

An ischemic stroke occurs when the blood flow to the brain reduces because of blocked or narrow arteries. In a study by Charles Esenwa and Jose Gutierrez, it was found that stroke is one of the major causes of mortality across the world and is the fifth leading cause of death.

Risk factors leading to ischemic stroke

There are various factors that are not under our control and we cannot modify them for providing the care for secondary stroke. These include the age of the patient, gender, etc.

But at the same time, there are several controllable factors which we can modify through adjustments in lifestyle, pharmacological interventions and surgical interventions. These are aimed to reduce the risks of a secondary stroke.

1. Smoking

Many studies have identified that one of the major and independent factors for an ischemic stroke is smoking.

The reason? Smoking leads to vasoconstriction (the blood vessels become narrow because of the muscular walls contract). This vasoconstriction can also reduce the stenoses of penetrating intracranial arteries that cause SVD (Small Vessel Disease).

2. Consumption of alcohol

Alcohol consumption is most commonly depicted by a J-shaped curve where the number of drinks consumed per day does not have a significant effect on the risk of dying. But as you start gulping down more and more glasses, the graph starts rising to form a curve looking like a J.

The relationship between alcohol consumption and ischemic stroke is also a J-shaped curve. While the risk of stroke is low in moderate drinkers, the heavy drinkers are more prone to an ischemic stroke. Why does this happen? Regular consumption of alcohol is often related to the increase in blood pressure.

If you are having 1 or 2 drinks in a week, you might actually be rising the high-density lipoprotein (HDL) cholesterol levels which are useful against coronary artery disease (CAD).

3. Obesity

Obesity is not so well related to cardiovascular diseases but there are recent studies which identify that abdominal obesity is related to the ischemic stroke.

With obesity, the person develops issues related to high blood pressure, high cholesterol level and low glucose levels. Obesity is an effect that is caused by several of the risk factors. When these risk factors combine, people who are obese naturally develops a probability of an ischemic stroke.

Methods of secondary stroke prevention as per issues

A secondary stroke can be prevented with the help of several specific mechanisms deployed in a clinical situation. These are –

1. Atrial fibrillation

People who are suffering from atrial fibrillation are the most prone to a stroke. If in a person, the atrial fibrillation is due to a non-valvular cause, the risk of a stroke can be measured using CHADS2 or CHADS2-VASc prediction scoring systems.

2. Prosthetic cardiac valves

In the patients having mechanical valves, the risk of embolism is 4% per year. Hence, the patients with mechanical valves have anticoagulation and are suggested to take warfarin with low dose aspirin.

The patients having bioprosthetic valves are less prone to embolism than the ones with mechanical valves. For them, the recommendation is a single antiplatelet.

3. Low ejection fraction

The patients either develop a thrombus or embolisation. In thrombus, the patients display low ejection fraction, the EF worsen and wall dyskinesis is seen.

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