When You Need to Act FAST

Stroke expert Dr. Basit Rahim talks about how to spot this potentially deadly health emergency, what to do and how you can reduce your risk.

Providence Mission Hospital neurologist Basit Rahim, MD, specializes in diagnosis and treatment of medical problems related to the brain, including stroke. Here he discusses the basics of stroke: what it is, why it happens and how to deal with it if it happens to you or a loved one.

What is a stroke?
“Stroke” is an umbrella term that refers either to an ischemic stroke or a hemorrhagic stroke. Ischemic stroke is where there’s an obstruction of oxygen to the brain and you have tissue breakdown.

The other kind is the hemorrhagic stroke, which is the bleeding type. That occurs when there’s a rupture of a blood vessel into the brain. About 85% of strokes are ischemic and about 15% are hemorrhagic.

Why do strokes happen?
For ischemic strokes, it’s risk factors of high blood pressure, diabetes, smoking, family history and atrial fibrillation. For hemorrhagic strokes, it’s high blood pressure and also blood thinners that can cause those types of bleeds.

Is a stroke painful?
The ischemic stroke does not hurt. However, when you have a hemorrhagic stroke, which is the much less common type, you may have a severe headache.

Can you have a “silent” stroke?
Yes. Not all strokes result in symptoms, so you can have a stroke without any clinical symptoms. But even without symptoms, a stroke is still dangerous, right? That is correct. It tells me that you’re at risk for more strokes.

Why is rapid treatment so critical?
We have a medication that’s called tenecteplase or alteplase that’s given for the ischemic type of stroke. These tissue-type plasminogen activators (tPA) have to be given within the first four and a half hours. With a hemorrhagic stroke it’s also essential to get to the hospital quickly so we can control your blood pressure and give you medications to reverse any kind of abnormal coagulopathy, meaning that if your blood is thinned, we can treat you so the bleeding doesn’t get worse.

Why is it helpful to remember the acronym “FAST”?
I actually like to expand it to “BE FAST.” It gives you a way to remember the signs or symptoms. The B is for balance, E is for eyes, F is for face, A is for arms, S is for speech and T stands for time. That tells you that if you have any of these symptoms—loss of balance, visual disturbance, facial drooping, arm weakness, slurred speech—you may have had a stroke and it’s time to get help. If the symptoms are one-sided, then it’s definitely a stroke until proven otherwise. To reduce your risk for stroke, consult your primary care provider.

Are you at risk for stroke?
While anyone can have a stroke—even babies—your risk increases as you get older. And the risk is higher for Black and Hispanic people. Age and race are factors you can’t change, but there are many things you can do to reduce your risk, including:

  • Get your blood pressure under control. High blood pressure is the top risk factor for stroke, so work with your doctor to lower your blood pressure if it’s 140/90 or higher.
  • Manage your diabetes. High blood sugar harms blood vessels, which puts you at increased risk of developing a blockage that can lead to stroke.
  • Stop smoking. Smoking almost doubles risk for ischemic stroke.
  • Maintain a healthy weight. Being overweight, especially if you carry a lot of weight around your middle, increases risk.
  • Exercise. Getting about 150 minutes a week of moderate exercise helps cut risk.
  • Don’t binge drink or use recreational drugs. Drinking alcohol, especially binge drinking, raises risk. So does using drugs like cocaine and methamphetamine.
  • Make sure you don’t have afib. Several heart conditions increase risk, but afib (atrial fibrillation) is the top one.
  • Check the Rx drugs you take. For women, using birth control or hormone replacement prescriptions that contain estrogen increases risk. If you take a blood thinner, talk to your doctor about monitoring the dose to reduce risk of a bleeding stroke.

To find a doctor, visit providence.org/doctors.

Providence Mission Hospital, already recognized as a Comprehensive Stroke Center by The Joint Commission, was honored in 2022 with the American Heart Association/American Stroke Association’s Get With The Guidelines® Gold Plus award.

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