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The major risk factors for stroke are hypertension, diabetes, cardiovascular disease, obesity, and being a male. These also happen to represent the same high risk group for COVID-19 infected patients.
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What Is the COVID-19 and stroke connection?
As we learn more about this infection, we’re realizing that this virus really likes to attack the vasculature and that’s the very problem in stroke victims. Those risk factors are diabetes, heart disease, and morbid obesity. Those patients tend to have high blood pressure, which is a blood vessel disease. And, that is the same thing that affects not only stroke patients, but it also seems this virus really likes to infect this cohort of people.
An additional finding is that the infection occurring in hospital-admitted patients tends to cause more blood clots in the bloodstream, especially in the arterial bloodstream. This is the bloodstream that oxygenates the brain, and those are the very blood vessels that can end up with clots that lead to the stroke.
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Treatment Continues Uninterrupted, Despite the Pandemic
Throughout the pandemic, there have been many concerns about receiving treatment, safely, for non-COVID health conditions. Dr. Dailey assures that no matter the condition, UPMC is ready to address it.
If you come in with a respiratory illness and are found to have COVID-19, we support you through that respiratory illness. If you have COVID-19, your respiratory illness, and you also happen to experience a stroke, we not only support you through your respiratory illness, but we also treat you just like any other stroke patient. Because we have the science to support that.
When a stroke is detected within a four and a half-hour window, patients are given a “clot buster” called tPA (tissue Plasminogen Activator). This ensures a good chance of saving brain tissue, correcting symptoms, and improving one’s ability to recover from the stroke.
Should a CT angiogram reveal a blog clot, patients are sent to a neurosurgery center where the clot can be removed.
Stroke patients receiving tPA are monitored closely for 24 hours in the intensive care unit (ICU) to make sure there are no complications from the medication. Physical therapy, occupational therapy, and speech therapy are initiated after those 24 hours.
We control your blood pressure, we address all of the risk factors, and we progress you through those therapies. Because after you have a stroke, we try to mitigate the risk for the next stroke. If you are not a candidate for tPA, we send you to a different floor where we initiate the physical therapy, occupational therapy, and speech therapies immediately. We interact with you and use those therapies on a daily basis.
When patients are well enough to go home, they will continue these regimens as a part of an outpatient therapy program—if they are consistently testing negative for the COVID-19 virus.
Again, we’re continuously learning more about this infection. Understandably, acute rehabs are being extremely cautious. Some rehabs are requiring two negative COVID PCR tests. What that means is we’re checking your respiratory airways to try to detect the virus. It is not a blood test and we do not know if you’re contagious at that point. But, I think we all understand in the medical community why acute rehabs want to be very cautious with patients until we know more about how the contagion acts after recovering from the respiratory illness.
Why It Is So Important to Act FAST
Despite the perceived uncertainty of heading to the emergency room during the COVID-19 pandemic, Dr. Dailey cautions people not to wait if they suspect they are having a stroke or even a more “mild” TIA (transient ischemic attack)—which often leads to a full-blown stroke.
The American Heart Association has done a good job of promoting the “FAST” assessment for stroke, alerting an increasing number of people why it’s so critical to act fast when a stroke occurs. The acronym represents:
- Face: Ask the person to smile, watch for one side of the face drooping.
- Arm: When the person raises their arms, does one drift downward?
- Speech: Is the person’s speech slurred, especially when repeating a simple phrase? Are they missing words or substituting words?
- Time: As soon as any symptoms present, call 911 immediately to allow the best chance of saving brain tissue and promoting recovery.
To learn more about stroke and how the COVID-19 virus is impacting risk and care procedures, listen to a podcast interview on this topic with Dr. Dailey.
Featuring Elena R. Dailey, MD
Editor's Note: This article was originally published on , and was last reviewed on .
The UPMC Adult Congenital Heart Disease (ACHD) Center is a joint program between UPMC Children’s Hospital of Pittsburgh and UPMC Heart and Vascular Institute. We provide long-term care for adolescents, young adults, maternal patients, and adults with congenital heart disease. Our goal is to provide complete care from your childhood all the way through your life. Our team of experts has a wide knowledge of heart conditions.