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HEART Insight:
doi: 10.1097/01.HEARTI.0000437031.55798.ed

Act FAST to Recognize the Signs of Stroke

Farley, Todd

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Donna Arnett, Ph.D., M.S.P.H., is the immediate past president of the American Heart Association and the chair of epidemiology at the University of Alabama School of Public Health. But 27 years ago she was a young, healthy clinical nurse working in a cardiologist's office. To say that she didn't see a stroke in her immediate future is putting it mildly.

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“It was completely unexpected,” Donna says of having a stroke at that young age.

But stroke can and often does occur without warning, and its effects can be devastating: Stroke is the fourth-leading cause of death in the United States and a leading cause of disability. The good news is that unlike the era when Donna had her stroke, today there are medications that effectively treat ischemic stroke (87 percent of the approximately 795,000 strokes that occur in the U.S. each year are ischemic).

During an ischemic stroke, blood flow to the brain is stopped due to a blockage or clot in a blood vessel. A drug called tissue plasminogen activator, or tPA, can help open a blocked blood vessel, providing it's delivered quickly enough. Restarting blood flow to the brain helps reduce brain damage, but studies have shown tPA must be administered within 3 to 4½ hours of a stroke's first symptoms to be effective. tPA is the only proven and widely available drug that can limit or even eliminate the bad effects of a stroke. The drug can't be given until various tests (including blood tests, physical examinations and brain scans) are run, however, all of which take time.

For people experiencing the symptoms of ischemic stroke, therefore, time is of the essence (or as the American Heart Association/American Stroke Association says, “Time lost is brain lost”). The symptoms of stroke need to be recognized quickly and immediate action needs to be taken.

Fortunately, says Ralph Sacco, M.D., M.S., F.A.H.A., F.A.A.N., chairman of neurology at the Miller School of Medicine, University of Miami, and past president of the AHA, that entire process has been streamlined to deal with the urgency of stroke. “From the moment you get in the door of a stroke center until the time you get the needle for the tPA should be less than an hour,” he says. “The AHA/ASA tries to get stroke centers to perform so the ‘door to needle’ time should be less than 60 minutes.”

Given the limited time frame for the drug's effectiveness and the approximate hour needed at a stroke center or emergency room before it can be given, it's no surprise Sacco estimates that only about 5 percent of ischemic stroke sufferers currently receive tPA as a treatment. Responding quickly to the symptoms of stroke is really the only hope one has of ever getting the drug, which is why it's so important to act F.A.S.T. in dealing with the symptoms of stroke.

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F.A.S.T. is the acronym being promoted through the AHA/ASA's Together to End Stroke initiative as an easy way to remember the sudden signs of stroke. The F stands for face drooping, the A for arm weakness and the S for speech difficulty, all of which are major symptoms of stroke. The T stands for time, which emphasizes the severity of the situation and indicates the need to immediately call 911. You can learn more about F.A.S.T. by visiting, where you can also download a free app for both iPhone and Android users that can help you quickly recognize the signs of stroke and award-winning hospitals in your area.

It's important to be familiar with all stroke signs, some of which aren't included in the easy-to-remember F.A.S.T. acronym:

* Sudden numbness or weakness of the face, arm or leg, especially on one side of the body

* Sudden confusion, trouble speaking or understanding

* Sudden trouble seeing in one or both eyes

* Sudden trouble walking, dizziness, loss of balance or coordination

* Sudden, severe headache with no known cause

Most important about all those symptoms, F.A.S.T. or not, is that they should not be ignored. It's often hard to tell if you or someone else is having a stroke, so even if you're not sure if it's really a stroke it's important to seek help early—don't ignore or minimize symptoms. The signs of a stroke are never good, and immediate action must be taken. The only way to be assessed for treatment options like medical devices and to get the tPA that is the most effective treatment for acute ischemic stroke is by acting FAST and calling 9-1-1.

© 2013 by the American Heart Association