Treatment of ischemic stroke

Treatment of ischemic stroke more effective the earlier it is started. That is why these patients should necessarily be admitted to specialized departments. Not only are hospitalized patients with severe impairment of consciousness and basic life functions (breathing, circulation).

Treatment is carried out in several directions:

• first aid, aimed at elimination of violations related to the maintenance of life (treatment of acute cardiovascular disorders, respiratory disorders, reduction of cerebral edema, high body temperature, prevention and treatment of complications, and so on);
• restoration of blood flow in the affected area (used medication for dissolving blood clots in the thrombotic nature of the stroke, drugs that reduce blood viscosity, vasodilators, drugs, strengthens the vascular wall, and so on) - all of this is especially important in the first 3 hours, after 6 hours of this therapy becomes ineffective; for the same purpose used surgical treatments - surgical repair of blood circulation in the affected area of ​​the brain, including through reconstructive operations on arteries, remove a blood clot from a blood vessel;
• maintaining the normal functioning of the brain (used drugs that reduce the toxic effect of the decay products of tissues, regenerating tissues and improves metabolic processes in them);
• medical rehabilitation; divided into the nearest medical rehabilitation (restorative and breathing exercises, massage sessions with a speech therapist Speech - when to resort to the help of a doctor , Drug rehabilitation treatment), the period of restoration of the disturbed functions (the same techniques, but used more widely), the recovery period (active motor mode, therapeutic exercises, physiotherapy) and the period of the consequences of cerebral blood flow (the correct mode, active lifestyle, regular monitoring at doctor).

Medications

Patients with ischemic stroke, can be assigned to receive the following drugs:

• Alteplase - medication, which breaks down blood clots and helps restore blood flow to the brain. It is administered to a patient by intravenous infusion over three hours of symptom onset of ischemic stroke Ischemic stroke - symptoms: what should pay attention .
• Aspirin and dipyridamole klopidogel used to reduce the risk of clot formation after stroke Stroke - a serious brain injury . They are given to a patient in form of tablets or administered through a tube inserted in the nose. Sometimes aspirin is given in the form of suppositories are administered into the rectum. It can also be assigned to a long course of receiving one of these medications.
• Warfarin and heparin also is used to prevent clot formation and ischemic stroke.

In addition to these drugs the patient may be prescribed medications that control blood pressure Blood pressure - dangerous if his swing?   and lowering cholesterol levels.

Surgery

Some patients who have had an ischemic stroke, can be assigned to surgery. As a rule, its purpose - the removal of fat deposits and arteries in the neck (the name of the surgery - carotid endarterectomy). This will reduce the risk of recurrent stroke. Typically, such an operation is carried out for two weeks after ischemic stroke. However, it should be borne in mind that it is not suitable for all patients.

Rehabilitation

After an ischemic stroke, many patients have to re-learn basic skills or acquire new ones - to adapt to the damage that caused the body to stroke.

It is difficult to say in advance how long it will take a recovery after a stroke. Most people largely recovered within the first weeks or months. The rehabilitation process will continue after hospital discharge. It includes work with a physical therapist, speech therapist, ophthalmologist, psychologist, and other experts.

The group of drugs - calcium channel blockers

Calcium ions play an important role in the regulation of vital functions of the organism: they penetrate into the cells to activate it metabolic processes that implement the physiological functions of these cells. The calcium ions enter the cell by special calcium or "slow" channels (as opposed to the "fast" channel, which received other substances). Calcium ions contributed to increasing the contractility of the myocardium (heart muscle), affect the conduction of nerve impulses, causing vasoconstriction and others.

If you slow down the passage of calcium ions through the channels into the cell, then expand coronary vessels (feeding the heart muscle), lower blood pressure and normal heart rhythm. For some drugs the group of calcium antagonists, these properties are manifested in different ways.

What is verapamil and its mechanism of action

Verapamil - is an antagonist of calcium ion which is able to selectively block the calcium channels. It is used to treat angina Treatment of angina - a versatile approach , Hypertension and arrhythmias. By blocking the flow of calcium ions into cells verapamil it has a triple action: it dilates the coronary vessels, lowers blood pressure and normalize heart rhythm.

Verapamil decreases myocardial oxygen demand by reducing myocardial contractility and heart rate deceleration, as well as helps to increase the amount of potassium in the cell capable of improving cardiac function.

Blood pressure lowering effect of verapamil associated with reduced smooth muscle tone of the peripheral arteries and the ability to reduce the total peripheral vascular resistance.

Efficient antiarrhythmic effect of verapamil is due to exposure to the atrioventricular node and sinus (normal) rhythm. In paroxysmal (paroxysmal) tachycardia, reduced the frequency of attacks of tachycardia. A normal heart rate is unchanged or declining slightly.

Verapamil inhibits aggregation (bonding) platelets, prevents blood clots and is not addictive, so the therapeutic effect in his regular admission only increased.

Which diseases take

Verapamil is shown under the following conditions:

• chronic coronary insufficiency (coronary heart disease);
• Hypertension, including hypertensive crisis cupping;
• treatment and prevention of arrhythmia (paroxysmal tachycardia, fibrillation and atrial flutter, arrhythmia, etc.).

Contraindications

Like any effective drug, verapamil has a lot of contraindications:

• low blood pressure (the "upper" pressure below 90 mm Hg);
• heart rate and heart rate less than 50 beats per minute;
• heart block degree II-III;
• Chronic heart failure stage II-III, acute heart failure;
• overdose of cardiac glycosides;
• severe stenosis (narrowing) of the aorta;
• Complications of acute myocardial infarction;
• porphyria (a hereditary metabolic disorder Metabolism: The basis of life of all living things Causing increased sensitivity to solar radiation);
• Hypersensitivity to the drug;
• the first 3 months of pregnancy and lactation Breast-feeding: feed - and no nails! .

Whether there is an overdose of verapamil

Overdose verapamil can cause a sharp drop in blood pressure, heart failure, heart block, cardiogenic shock. In case of overdose should stop taking the drug, the patient is better put in the hospital, stomach wash. Administered intravenously administering various drug solutions, as well as activated charcoal Activated carbon - old but indispensable   (it adsorbs and removes poisons), and a laxative.

What side effects may cause verapamil

In compliance with the recommended dosing regimen verapamil well tolerated, but, nevertheless, there may be side effects:

• on the part of the cardiovascular system: facial flushing, heart block, a sharp drop in blood pressure, heart failure;
• From the digestive system: nausea, diarrhea or constipation, abnormal liver function;
• the central nervous system: dizziness, headache; seldom - nervousness, confusion, drowsiness, fatigue, impaired concentration, "chills" through the body;
• on the part of the endocrine system: rarely - increased and breast tenderness in the elderly, especially during prolonged therapy;
• on the part of the musculoskeletal system: pain in the muscles and joints;
• Allergic reactions: skin rash, itching, hives, angioedema;
• Other: bronchospasm (intravenous), edema.

As you know, not the drug verapamil, which can be taken without a doctor's prescription, it requires careful and thoughtful use.

  Galina Romanenko