Royal College of Physicians - Stroke Guidelines

As some of us in this forum have had TIAs and strokes, the following guidelines may be useful:

The "easy-read" version of the guidelines for patients and carers is available at:

strokeaudit.org/Guideline/P...

The full version for clinicians - but don't let that put you off reading it - is available at:

strokeaudit.org/Guideline/F...

John

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  • Thank you. I had a quick look and have downloaded the PDF version as there is a huge amount of useful information.

  • PS However, page 23 states that an anticoagulant thins the blood!

    This, like the woeful use of decimate (to reduce by one tenth) and panninis (one pannino, two pannini) looks like a battle lost.

  • Thank you for posting this. The easy read version is excellent and very easy to follow. Full version later . . .

  • Thank you John Boy. Useful for anybody regardless of if or when and you get to learn lots of new greek words like dysphagia.

  • This is not a forum to sit back, so if there's something that needs correcting or an explanation, we should feel free to contact the Royal College of Physicians. Some of the things that jumped out at me:

    * 5.7 : In about a quarter of people with stroke, and more commonly in younger age groups, no cause is evident on initial investigation.

    * 5.7.1 : PAF may not be detected by a standard 12-lead ECG and may require more prolonged monitoring;

    * 5.7.1 : There is no consensus concerning the shortest duration of PAF that constitutes a risk of cardioembolism, though many studies have used a threshold of 30 seconds;

    My thoughts:

    * If no cause is evident on initial investigation in 25% of people with a stroke, how do we prevent it?

    * monitoring for PAF needs to be longer;

    * short-term PAF poses a risk.

    Turning to the version for patients and carers, exercise is recommended for stroke patients, but there are no guidelines and, my consultant neurologist advised that there haven't been clinical studies. The recommendations assume that surviving stroke patients are overweight and have unhealthy life styles; the vascular clinic that I attended after the stroke expected the same sterotype. If you don't fit that profile whether or not you have AF, there are no recommendations beyond taking an anticoagulant.

    There is much in AF and stroke that needs to be resolved. Hopefully, the second phase of stem cell treatment post-stroke will be fruitfull. In the meantime in the words of Dixon of Dock Green (yes I am that old), "mind how you go".

  • When I attended cardio rehab I always objected that the talk discussion part always tended to put the blame for it on the patients lifestyle.

  • Entirely agree and I think so will the elite and endurance athletes who post on this site, as well as all of us who used to be slim, fit and energetic until AF descended!

  • My AF resulted from my aortic valve replacement. None of my pre-surgery research, the pre assessment or the consent form warned me of a + 33% chance of that happening, Of course even knowing that I would have still had the surgery or I would not be writing this.

  • I was in A&E, blind on one side from the stroke and just before thrombolysis the consultant quickly said; this could leave you blind. Not a lot of choice then!

  • When I went to see the surgeon prior to the operation he said that I had about a 20% chance of not surviving it. The hospital was on the Downs overlooking Brighton Racecourse and I wondered if they would give me better odds down there.

    Did you have AF at the time of your stroke?

  • I've only had AF that I've been aware of during some fairly hard work in the gym. Even then it only reduce my power output, so a 12.5 km row in 60 minutes was reduced to 12.2 km. On the day that I had a stroke, I hadn't been to the gym for two or three days, I was relaxed and pottering in the garden shed.

  • Sorry, was that prior to the stroke?

  • Most of my records for the week of the stroke are missing. The stroke was on 6th July. On 1st July the gym session was Concept 2 rowing machine, Marpo rope machine, abbs work and stretching. My 80% MHR was 150bpm. I rowed just over 5 km at maximum resistance in 22:47 at an average of 138 watts and 153 bpm, with the last 3 minutes in AF at 191 bpm and 129 to 134 watts. I did four x 5 minute sets of different exercises on the rope machine at almost maximum resistance. The abbs work was 25 pendulums. My heart rate on a one second sample for the whole session was spikey with a maximum spike of 222 bpm. In the week before the stroke some of my systolic readings were over 90. On the day before the stroke my blood pressure was 117/81 with a pulse of 44 bpm.

    You can see from those figures that although medical text books quite a 30% reduction in power output during AF, it hardly affected me.

  • I should add that my ithlete app that measures the r-r interval was not able to read a value over 55 seconds, which probably indicated a low level of flutter.

  • Your prior fitness must have stood you in good stead after the stroke.

    Royal College of Physicians reminds me that when first married in 1902 my Granny lived at 11 Queen Street in Edinburgh next door to the Scottish Royal College of Physicians ornate building. My mother and all her siblings were born there. Some years ago the College extended into her old home.

  • There is a view that long-term aerobic exercise can lead to AF. That may be true, but my fitness has fought off some life threatening or potentially disabling conditions. I would say to my younger self: keep exercising but back off the intensity a little and, if two EPs give contradictory opinions take the more conservative advice.

    I recall a poster of a sinking ship that said something like; "Some people serve as a warning to others".

  • After the Titanic one should have known to avoid its sister ship.

  • There are clearly some people whose stroke cannot be prevented.

    There are a lot of people with asymptomatic undiagnosed af and even more with undiagnosed paf. This does make a case for screening for asymptomatic af as happens now in many flu clinics and routine GP contacts.

  • The Flu clinics I have been have all had a very rapid turnover with no time for any screening. Though last year they were asking us aged patients if we wanted to book a future memory consultation.

  • If it was a rapid turnover they could only check for a raised pulse or arrythmia. A high speed ECG with multiple leads would detect some flutter but it doesn't sound as though that was happening in your flu clinics.

  • No way! It was jacket off and sleeves up before going in to have it done and out in seconds. At one practice where it was all hands on deck the jabs were even being done in the foyer and corridor as they had more doctors there than available surgeries.

    Now Tesco and Asda are doing NHS flu injections. Has anyone had one there?

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