Mercy Cardiac-Stroke Center

The Center's interdisciplinary care team includes specially trained nurses (Neurovascular Certified), dietitians, rehabilitation services, counseling and pastoral care. A dedicated clinical nurse specialist oversees care for neuro-medical patients, in particular stroke patients, also providing education and support for these patients and their families. This team approach focuses on comprehensive services, ensuring that individual patient needs are identified and addressed, and recovery is progressive. This involves continual data and process improvement monitoring.

When someone has shown symptoms of a stroke or a TIA (transient ischemic attack), a doctor will gather information and make a diagnosis. He or she will review the events that have occurred and will:

• get a medical history
• do a physical and neurological examination
• have certain laboratory (blood) tests done
• get a CT or MRI scan of the patient
• study the results of other diagnostic tests that might be needed

At Mercy, stroke rehabilitation starts on the day of admission to ensure that patients begin receiving rehabilitation early in the course of illness. By providing physical therapy, occupational therapy, speech therapy and social services from the onset of admission, Mercy strives to improve patient outcomes.

Mercy's Cardiac-Stroke Center provides 31 private rooms and a warm, healing environment that enhances care and patient comfort. In addition, overnight accommodations are available for family members, as well as a business desk for laptop computer use and Internet access.

The only FDA-approved treatment for ischemic strokes is tissue plasminogen activator (tPA, also known as IV rtPA, given through an IV in the arm). tPA works by dissolving the clot and improving blood flow to the part of the brain being deprived of blood flow. If administered within three hours (and up to 4.5 hours in certain eligible patients), tPA may improve the chances of recovering from a stroke. A significant number of stroke victims don’t get to the hospital in time for tPA treatment; this is why it’s so important to identify a stroke immediately.

The Mercy Stroke Clinic is dedicated to the prevention of stroke and recurrent stroke. An appointment is scheduled four to six weeks after hospitalization and patients meet with a nurse practitioner and Robert Struthers, MD, PCI Neurology. Information covered at this visit includes:

• Why your stroke or TIA (Transient Ischemic Attack) occurred.
• Explanation of tests while hospitalized.
• Review of medications to prevent stroke and completion of a stroke risk reduction plan.
• Education to decrease your risk factors and increase your stroke knowledge
• Review of your current rehabilitation and plan for the future.
• Schedule diagnostic tests, if needed.
• Information about community support for stroke.

About 30% of patients who have a stroke go on to have a second stroke within five years. Controlling risk factors and stroke-specific education can help reduce this risk.

The clinic is held at the neurology clinic at PCI.

Stroke risk factor tools provide an interactive way to test your knowledge on areas such as the signs of a stroke, national statistics on strokes, and how to reduce your risk of having a stroke.

Patients and families affected by stroke are encouraged to attend meetings for support, have questions answered and more. Guest speakers will talk about topics ranging from rehabilitation, prevention of a second stroke and caretaker issues. This is a positive time to share and gather ideas.

This support group takes place on the fourth Tuesday of every other month.
5 to 6:30 p.m.
Katz Conference Room
Ground Level
Mercy Medical Center

Park in the 8th Ave. & 8th St. parking ramp.
Enter via south entrance on ground level.

For more information, contact Jennifer Austin, RN, Mercy Stroke Coordinator at (319) 440-0312.

Control High Blood Pressure

High blood pressure damages blood vessels causing plaque to accumulate on the damaged surface and blood clots to form. This can result in a stroke. Blood pressure readings of 140/90 or higher is considered high; target blood pressure should be under 120/80. Eating a healthier diet, exercise and maintaining a healthy weight can help control blood pressure. Take your blood pressure medications as prescribed by your physician.

Keep Cholesterol Under Control

Total Cholesterol under 200; HDL Cholesterol above 40 (for men) above 50 (for women); LDL Cholesterol under 70.

Keep Diabetes Under Control

Check blood glucose and take medications, exercise and eat a healthy diet.

Stop Smoking

Smoking damages blood vessels causing plaque to accumulate and blood clots to form.

Limit Alcohol Use

Men: Less than two drinks a day and women less than one drink per day.

Choose an Active Lifestyle

Engage in an exercise program; walk at least 30 minutes per day if capable.

Healthy Diet

Diet rich in fruits and vegetables, low fat, low salt, and reduce calories, as needed.

For community education, please contact Jennifer Austin, RN, Mercy Stroke Coordinator at (319) 440-0312.

Face Drooping – Does one side of the face droop or is it numb? Ask the person to smile. Is the person's smile uneven?

Arm Weakness – Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?

Speech Difficulty – Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence, like "The sky is blue." Is the sentence repeated correctly?

Time to call 9-1-1 – If someone shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get the person to the hospital immediately. Check the time so you'll know when the first symptoms appeared.

Other symptoms of stroke include:

• Sudden NUMBNESS or weakness of face, arm or leg, especially on one side of the body
• Sudden CONFUSION, trouble speaking or understanding speech
• Sudden TROUBLE SEEING in one or both eyes
• Sudden TROUBLE WALKING, dizziness, loss of balance or coordination
• Sudden SEVERE HEADACHE with no known cause

Why Call 911?

• When a stroke occurs, 1.9 million brain cells die per minute. There is no time to waste.
• The fastest way to the hospital is by ambulance.
• The EMTs will call ahead and alert the Emergency Department of your arrival so everything is ready when you arrive.
• Responding quickly will allow you to benefit from clot-busting medication - tPA - Tissue Plasminogen Activator, a medication that can actually break up the clot that is blocking the blood vessel.
• This treatment must be started soon after symptom onset – NOTE TIME OF SYMPTOM ONSET and call 911 and come to the Mercy Medical Center Emergency Department.

IMPORTANT – CHECK THE TIME SO YOU WILL KNOW WHEN SYMPTOMS APPEAR

• Ischemic stroke accounts for about 87% of all cases.
• Ischemic strokes occur as a result of an obstruction within a blood vessel supplying blood to the brain. The underlying condition for this type of obstruction is the development of fatty deposits lining the vessel walls. This condition is called atherosclerosis. These fatty deposits can cause two types of obstruction:
  • Cerebral thrombosis refers to a thrombus (blood clot) that develops at the clogged part of the vessel.
  • Cerebral embolism refers generally to a blood clot that forms at another location in the circulatory system, usually the heart and large arteries of the upper chest and neck. A portion of the blood clot breaks loose, enters the bloodstream and travels through the brain's blood vessels until it reaches vessels too small to let it pass. A second important cause of embolism is an irregular heartbeat, known as atrial fibrillation. It creates conditions where clots can form in the heart, dislodge and travel to the brain.
• Silent cerebral infarction (SCI), or “silent stroke,” is a brain injury likely caused by a blood clot interrupting blood flow in the brain. It’s a risk factor for future strokes that could lead to progressive brain damage due to these strokes.

• Hemorrhagic stroke accounts for about 13 percent of stroke cases.
• It results from a weakened vessel that ruptures and bleeds into the surrounding brain. The blood accumulates and compresses the surrounding brain tissue. The two types of hemorrhagic strokes are intracerebral (within the brain) hemorrhage or subarachnoid hemorrhage.
• Hemorrhagic stroke occurs when a weakened blood vessel ruptures. Two types of weakened blood vessels usually cause hemorrhagic stroke: aneurysms and arteriovenous malformations (AVMs).
• An aneurysm is a ballooning of a weakened region of a blood vessel. If left untreated, the aneurysm continues to weaken until it ruptures and bleeds into the brain.
• An arteriovenous malformation (AVM) is a cluster of abnormally formed blood vessels. Any one of these vessels can rupture, also causing bleeding into the brain.

• While transient ischemic attack (TIA) is often labeled “mini-stroke,” it is more accurately characterized as a “warning stroke,” a warning you should take very seriously.
• TIA is caused by a clot; the only difference between a stroke and TIA is that with TIA the blockage is transient (temporary). 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.
• Why do some clots dissolve while others don’t? The body has naturally occurring clot-busting agents. Whether there is damage depends on how long the clot is in place; because there is no way to predict when a clot will dissolve on its own, time is of the essence.
• While the vast majority of strokes are not preceded by TIA, about a third of people who experience TIA go on to have a stroke within a year. TIA is a warning stroke and gives a patient time to act and keep a permanent stroke from occurring.
• If a survivor experiences TIA after they have had a stroke, they should go to the emergency room immediately because something in their treatment plan has not worked.
• In essence, there should be no difference in response to a TIA or a stroke. Although a TIA resolves itself before there is damage, there is no way to predict which clots will dissolve on their own. Stroke — and TIA — are medical emergencies; dial 9-1-1 and tell the operator you think it’s a stroke and note the time the symptoms started. Remember: Time lost is brain lost.

The effects of a stroke depend on several factors, including the location of the obstruction and how much brain tissue is affected. Because one side of the brain controls the opposite side of the body, a stroke affecting one side will result in neurological complications on the side of the body it affects. For example, if the stroke occurs in the brain's right side, the left side of the body (and the left side of the face) will be affected, which could produce any or all of the following:

• Paralysis on the left side of the body
• Vision problems
• Quick, inquisitive behavioral style
• Memory loss

If the stroke occurs in the left side of the brain, the right side of the body will be affected, producing some or all of the following:

• Paralysis on the right side of the body
• Speech/language problems
• Slow, cautious behavioral style
• Memory loss

When stroke occurs in the brain stem, depending on the severity of the injury, it can affect both sides of the body and may leave someone in a "locked-in" state. When a locked-in state occurs, the patient is generally unable to speak or achieve any movement below the neck.