Transient Ischemic Attack
A transient ischemic attack (TIA) is like a stroke, producing similar symptoms, but usually lasting only a few minutes and causing no permanent damage.
Often called a ministroke, a transient ischemic attack may be a warning. About 1 in 3 people who have a transient ischemic attack will eventually have a stroke, with about half occurring within a year after the transient ischemic attack.
A transient ischemic attack can serve as both a warning and an opportunity — a warning of an impending stroke and an opportunity to take steps to prevent it.
Transient ischemic attacks usually last a few minutes. Most signs and symptoms disappear within an hour. The signs and symptoms of TIA resemble those found early in a stroke and may include sudden onset of:
- Weakness, numbness or paralysis in your face, arm or leg, typically on one side of your body
- Slurred or garbled speech or difficulty understanding others
- Blindness in one or both eyes or double vision
- Dizziness or loss of balance or coordination
You may have more than one TIA, and the recurrent signs and symptoms may be similar or different depending on which area of the brain is involved.
When to see a doctor
Seek immediate medical attention if you suspect you've had a transient ischemic attack. Prompt evaluation and identification of potentially treatable conditions may help you prevent a stroke.
A transient ischemic attack has the same origins as that of an ischemic stroke, the most common type of stroke. In an ischemic stroke, a clot blocks the blood supply to part of your brain. In a transient ischemic attack, unlike a stroke, the blockage is brief, and there is no permanent damage.
The underlying cause of a TIA often is a buildup of cholesterol-containing fatty deposits called plaques (atherosclerosis) in an artery or one of its branches that supplies oxygen and nutrients to your brain.
Plaques can decrease the blood flow through an artery or lead to the development of a clot. A blood clot moving to an artery that supplies your brain from another part of your body, most commonly from your heart, also may cause a TIA
Some risk factors for transient ischemic attack and stroke can't be changed. Others you can control.
Risk factors you can't change
You can't change the following risk factors for transient ischemic attack and stroke. But knowing you're at risk can motivate you to change your lifestyle to reduce other risks.
- Family history. Your risk may be greater if one of your family members has had a TIA or a stroke.
- Age. Your risk increases as you get older, especially after age 55.
- Sex. Men have a slightly higher likelihood of TIA and stroke, but more than half of deaths from stroke occur in women.
- Prior transient ischemic attack. If you've had one or more TIAs, you're 10 times more likely to have a stroke.
- Sickle cell disease. Also called sickle cell anemia, stroke is a frequent complication of this inherited disorder. Sickle-shaped blood cells carry less oxygen and also tend to get stuck in artery walls, hampering blood flow to the brain.
- Race. Blacks are at greater risk of dying of a stroke, partly because of the higher prevalence of high blood pressure and diabetes among blacks.
Risk factors you can take steps to control
You can control or treat a number of factors — including certain health conditions and lifestyle choices — that increase your risk of stroke. Having one or more of these risk factors doesn’t mean you’ll have a stroke, but your risk particularly increases if you have two or more of them.
- High blood pressure. Risk of stroke begins to increase at blood pressure readings higher than 110/75 millimeters of mercury (mm Hg). Your doctor will help you decide on a target blood pressure based on your age, whether you have diabetes and other factors.
- High cholesterol. Eating less cholesterol and fat, especially saturated fat and trans fats, may reduce the plaques in your arteries. If you can't control your cholesterol through dietary changes alone, your doctor may prescribe a statin or another type of cholesterol-lowering medication.
- Cardiovascular disease. This includes heart failure, a heart defect, a heart infection or an abnormal heart rhythm.
- Carotid artery disease. The blood vessels in your neck that lead to your brain become clogged.
- Peripheral artery disease (PAD). The blood vessels that carry blood to your arms and legs become clogged.
- Diabetes. Diabetes increases the severity of atherosclerosis — narrowing of the arteries due to accumulation of fatty deposits — and the speed with which it develops.
- High levels of homocysteine. Elevated levels of this amino acid in your blood can cause your arteries to thicken and scar, which makes them more susceptible to clots.
- Excess weight. A body mass index of 25 or higher and a waist circumference greater than 35 inches (89 centimeters) in women or 40 inches (102 centimeters) in men increase risk.
- Cigarette smoking. Smoking increases your risk of blood clots, raises your blood pressure and contributes to the development of cholesterol-containing fatty deposits in your arteries (atherosclerosis).
- Physical inactivity. Engaging in 30 minutes of moderate-intensity exercise most days helps reduce risk.
- Poor nutrition. Eating too much fat and salt, in particular, increases your risk of TIA and stroke.
- Heavy drinking. If you drink alcohol, limit yourself to no more than two drinks daily if you're a man and one drink daily if you're a woman.
- Use of illicit drugs. Avoid cocaine and other illicit drugs.
- Use of birth control pills. If you use any hormone therapy, talk to your doctor about how the hormones may affect your risk of TIA and stroke.
Preparing for your appointment
A TIA often is diagnosed in an emergency situation, but if you're concerned about your risk of having a stroke, you can prepare to discuss the subject with your doctor at your next appointment.
What you can do
If you want to discuss your risk of stroke with your doctor, write down and be ready to discuss:
- Your risk factors for stroke, such as family history of strokes
- Your medical history, including a list of all medications, as well as any vitamins or supplements, you're taking
- Key personal information, such as lifestyle habits and major stressors
- Whether you think you've had a TIA and what symptoms you experienced
- Questions you might have
What to expect from your doctor
Your doctor may recommend that you have several tests to check your risk factors and should tell you how to prepare for the tests, such as fasting before having your blood drawn to check your cholesterol and blood sugar levels.
Treating high cholesterol
If you've been diagnosed with high cholesterol, you'll be advised to make changes to your diet and increase your level of exercise. After a few months, if your cholesterol level hasn't dropped, you may be advised to take cholesterol-lowering medication. Changing your diet, stopping smoking and exercising more will also help to prevent high cholesterol developing. The various treatments for high cholesterol are outlined below. You can also read a summary of the pros and cons of the treatments for high cholesterol, allowing you to compare your treatment options.
Eating a healthy, balanced diet that's low in saturated fats can reduce your level of LDL (bad cholesterol). Try to avoid or cut down on the following foods, which are high in saturated fat:
- fatty cuts of meat and meat products, such as sausages and pies
- butter, ghee and lard
- cream, soured cream, crème fraîche and ice cream
- cheese, particularly hard cheese
- cakes and biscuits
- milk chocolate
- coconut oil, coconut cream and palm oil
The government recommends that a maximum of 11% of a person's food energy should come from saturated fat. This equates to no more than:
- 30g of saturated fat a day for the average man
- 20g of saturated fat a day for the average woman
Children should have less.
Check the labels on the foods you're eating to find out how much saturated fat you're consuming.
Omega-3 fatty acids
Many experts believe that the fats found in avocados and oily fish, such as mackerel, salmon and tuna, are good for you. These are known as omega-3 fatty acids and high doses can improve (lower) triglyceride levels in some people. However, too much omega-3 fatty acids can contribute to obesity.
For people with a high triglyceride level, at least two portions of oily fish a week is thought to be beneficial. However, there's no evidence that taking omega-3 fatty acid supplements has the same benefit.
There are several different types of cholesterol-lowering medication that work in different ways. Your GP can advise you about the most suitable type of treatment, and may also prescribe medication to lower high blood pressure (hypertension) if it affects you.
The most commonly prescribed medications are outlined below.
Statins block the enzyme (a type of chemical) in your liver that helps to make cholesterol. This leads to a reduction in your blood cholesterol level. You'll usually be started on a medication called atorvastatin. Other statins include simvastatin and rosuvastatin. When someone has side effects from using a statin, it's described as having an "intolerance" to it. Side effects of statins include headaches, muscle pain and stomach problems, such as indigestion, diarrhoea orconstipation.
Statins will only be prescribed to people who continue to be at high risk of heart disease, because they need to be taken for life. Cholesterol levels start to rise again once you stop taking them.
In some cases, a low daily dose of aspirin may be prescribed, depending on your age (usually over 40 years old) and other risk factors. Low-dose aspirin can help to prevent blood clots forming, particularly for someone who's had a heart attack, has established vascular disease, or a high risk of developing cardiovascular disease (CVD).
You may also be advised to have periodic blood tests to ensure your liver is functioning well.
Ezetimibe is a medication that blocks the absorption of cholesterol from food and bile juices in your intestines into your blood. It's generally not as effective as statins, but is less likely to cause side effects.
You can take ezetimibe at the same time as your usual statin if your cholesterol levels aren't low enough with the statin alone. The side effects of this combination are generally the same as those of the statin on its own (muscle pain and stomach problems).
You can take ezetimibe by itself if you're unable to take a statin. This may be because you have another medical condition, you take medication that interferes with how the statin works, or because you experience side effects from statins. Ezetimibe taken on its own rarely causes side effects.
For more information, you can read the National Institute for Health & Care Excellence (NICE) guidelines about the use of ezetimibe for treating high cholesterol (PDF, 189kb).
Treating high blood pressure
You can take effective steps to lower your blood pressure with changes to your lifestyle and by taking medication. In all cases, you can benefit from making some simple lifestyle changes (outlined below). Whether you are also recommended to take medication will depend on your blood pressure level and your risk of developing a cardiovascular disease, such as a heart attack, stroke or kidney failure.
- If your blood pressure is consistently above 140/90mmHg (or 135/85mmHg at home) but your risk of cardiovascular disease is low – you should be able to lower your blood pressure by making some changes to your lifestyle (see below). You may be offered yearly blood pressure assessments.
- If your blood pressure is consistently above 140/90mmHg (or 135/85mmHg at home) but below 160/100mmHg – you will be offered medication to lower your blood pressure if you have existing or high risk of cardiovascular disease.
- If your blood pressure is consistently above 160/100mmHg – you will be offered medication to lower your blood pressure.
Find out about the health risks of not treating high blood pressure.
Read information about treating high blood pressure during pregnancy.
The various treatments for high blood pressure are outlined below. You can also read a summary of the pros and cons of the treatments for high blood pressure, allowing you to compare your treatment options.
Below are some changes you could make to your lifestyle to reduce high blood pressure. Some of these will lower your blood pressure in a matter of weeks, others may take longer.
- Drink less coffee, tea or other caffeine-rich drinks such as cola.
Drinking more than four cups of coffee a day may increase your blood pressure. You can take these steps today, regardless of whether or not you're taking blood pressure medication. You don’t need a doctor to prescribe lifestyle changes. The more healthy habits you adopt, the greater effect there is likely to be on your blood pressure.
In fact, some people find that, by sticking to a healthy lifestyle, they do not need to take any medicines at all. Find out more about preventing high blood pressure.
There is a wide range of blood pressure-lowering medicines to choose from and a combination is usually needed to treat high blood pressure most effectively and with the minimum side effects.
Taking such a combination of medication is nothing to worry about. The different types of medication work in different ways on your body. Read an FAQ page from Blood Pressure UK on Taking more than one medicine for high blood pressure.
The first medication you are offered will depend on your age.
- If you are under 55 years old – you will usually be offered an ACE inhibitor or an angiotensin receptor blocker (ARB).
- If you are aged 55 or older (or you're any age with African or Caribbean family origin) – you will usually be offered a calcium channel blocker.
In some cases, you may need to take blood pressure-lowering medication for the rest of your life. However, if your blood pressure levels stay under control for several years, your doctor might be able to reduce or stop your treatment.
It's really important you take your medications as directed. If you miss doses, the treatment will not work as effectively and you could lose protection against future illness. The medication won't necessarily make you feel any different, but this doesn't mean it's not working.
Here are some questions you might like to ask your doctor or nurse about your treatment.
You can also ask your pharmacist any questions about your medication, or approach them for advice on how to stick to your treatment plan.
Medications used to treat high blood pressure can have side effects but most people don't experience any. If they do, the large choice of blood pressure medicines means that they can often be resolved by changing treatments.
Let your GP or nurse know if you have any of the following common side effects while taking medication for high blood pressure:
- feeling drowsy
- pain around your kidney area (on the side of your lower back)
- a dry cough
- dizziness, faintness or lightheadedness
- a skin rash
- swelling of your feet
Angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure by relaxing your blood vessels. The most common side effect is a persistent dry cough. If side effects become particularly troublesome, a medication that works in a similar way to ACE inhibitors, known as an angiotensin-2 receptor antagonist (ARB), may be recommended.
ACE inhibitors can cause unpredictable effects if taken with other medications, including some over-the-counter ones. Check with your GP or pharmacist before taking anything in combination with this medication.
Find out more about ACE inhibitors.
Calcium channel blockers
Calcium channel blockers keep calcium from entering the muscle cells of the heart and blood vessels. This widens your arteries (large blood vessels) and reduces your blood pressure. Drinking grapefruit juice while taking some types of calcium blockerscan increase your risk of side effects. You can discuss the possible risks with your GP or pharmacist.
Find out more about calcium channel blockers.
Sometimes known as water pills, diuretics work by flushing excess water and salt from the body through urine.
Find out more about thiazide diuretics.
Beta-blockers work by making your heart beat more slowly and with less force, thereby reducing blood pressure. Beta-blockers used to be a popular treatment for high blood pressure, but now they only tend to be used when other treatments have not worked. This is because beta-blockers are considered to be less effective than the other medications used to treat high blood pressure.
Find out more about beta-blockers.
Treating atrial fibrillation
Treatments for atrial fibrillation include medications to control heart rate and reduce the risk of stroke, and procedures such as cardioversion to restore normal heart rhythm. It may be possible for you to be treated by your GP or you may be referred to a heart specialist (a cardiologist). Some cardiologists, known as electrophysiologists, specialise in the management of abnormalities of heart rhythm.
You'll have a treatment plan and work closely with your healthcare team to decide the most suitable and appropriate treatment for you. Factors that will be taken into consideration include:
- your age
- you overall health
- the type of atrial fibrillation you have
- your symptoms
- whether you have an underlying cause that needs to be treated
The first step is to try to find the cause of the atrial fibrillation. If a cause can be identified, you may only need treatment for this. For example, if you have an overactive thyroid gland (hyperthyroidism), medication to treat it may also cure atrial fibrillation.
If no underlying cause can be found, the treatment options are:
- medicines to reduce the risk of a stroke
- medicines to control atrial fibrillation
- cardioversion (electric shock treatment)
- catheter ablation
- having a pacemaker fitted
You'll be promptly referred to your specialist treatment team if one type of treatment fails to control your symptoms of atrial fibrillation and more specialised management is needed.
Medicines to control Atrial Fibrillation
Medicines called anti-arrhythmics can control atrial fibrillation by:
- restoring a normal heart rhythm
- controlling the rate at which the heart beats
The choice of anti-arrhythmic medicine depends on the type of atrial fibrillation, any other medical conditions you have, side effects of the medicine chosen and how well the atrial fibrillation responds.
Some people with atrial fibrillation may need more than one anti-arrhythmic medicine to control it.
Restoring a normal heart rhythm
A variety of medicines are available to restore normal heart rhythm, including:
- Beta-blockers, particularly sotalol
- Dronedarone (only for certain people)
An alternative medication may be recommended if a particular medicine doesn't work or the side effects are troublesome. Newer medicines are in development, but aren't widely available yet.
Controlling the rate of the heartbeat
The aim is to reduce the resting heart rate to under 90 beats per minute, although in some people the target is under 110 beats per minute.
A beta-blocker, such as bisoprolol or atenolol, or a calcium channel blocker, such as verapamil or diltiazem, will be prescribed.
A medicine called digoxin may be added to help control the heart rate further. In some cases, amiodarone may be tried.
Normally, only one medication will be tried before catheter ablation (see below) is considered.
As with any medicine, anti-arrhythmics can cause side effects. The most common side effects of anti-arrhythmics are:
- Beta-blockers – tiredness, coldness of hands and feet, low blood pressure, nightmares and impotence
- Flecainide – nausea, vomiting and heart rhythm disorders
- Amiodarone – sensitivity to sunlight (high-protection sunscreen must be worn or skin covered up), lung problems, changes to liver function or thyroid function (regular blood tests can check for this) and deposits in the eye (these disappear when treatment is stopped)
- Verapamil – constipation, low blood pressure, ankle swelling and heart failure
Read the patient information leaflet that comes with the medicine for more details.
Medicines to reduce the risk of a stroke
The way the heart beats in atrial fibrillation means there's a risk of blood clots forming in the heart chambers. If these enter the bloodstream, they can cause a stroke (see complications of atrial fibrillation for more information).
Your doctor will assess your risk and try to minimise your chance of having a stroke. They'll consider your age and whether you have a history of any of the following:
You may be given medication according to your risk of having a stroke. Depending on your level of risk, you may be prescribed warfarin or a newer type of anticoagulant, such as dabigatran,rivaroxaban or apixaban (see below).
If you're prescribed an anticoagulant, your risk of bleeding will be assessed both before you start the medication and while you're taking it. Aspirin isn't recommended to prevent strokes caused by atrial fibrillation.
People with atrial fibrillation who have a high or moderate risk of having a stroke are usually prescribed warfarin, unless there's a reason they can't take it.
Warfarin is an anticoagulant, which means it stops the blood clotting. There's an increased risk of bleeding in people who take warfarin, but this small risk is usually outweighed by the benefits of preventing a stroke.
It's important to take warfarin as directed by your doctor. If you're prescribed warfarin, you need to have regular blood tests and, after these, your dose may be changed.
Many medicines can interact with warfarin and cause serious problems, so check that any new medicines you're prescribed are safe to take with warfarin. Read more about how warfarin interacts with other medicines.
While taking warfarin, you should be careful about drinking too much alcohol regularly and avoid binge drinking.
Drinking cranberry juice and grapefruit juice can also interact with warfarin and isn't recommended.
Rivaroxaban, dabigatran and apixaban are newer anticoagulants and an alternative to warfarin.
The National Institute for Health and Care Excellence (NICE) has approved these medicines for use in treating atrial fibrillation. NICE also states that you should be offered a choice of anticoagulation and the opportunity to discuss the merits of each medicine.
Unlike warfarin, rivaroxaban, dabigatran and apixaban don't interact with other medicines and don't require regular blood tests. In large trials, the medicines have been shown to be as effective or more effective than warfarin at preventing strokes and deaths. They also have a similar or lower rate of major bleeding.
You can read more about these newer types of anticoagulants in the NICE guidance about the management of atrial fibrillation (PDF, 301kb).
Cardioversion may be recommended for some people with atrial fibrillation. It involves giving the heart a controlled electric shock to try to restore a normal rhythm. Cardioversion is usually carried out in hospital so that the heart can be carefully monitored.
If you've had atrial fibrillation for more than two days, cardioversion can increase the risk of a clot forming. In this case, you'll be given an anticoagulant for three to four weeks before cardioversion, and for at least four weeks afterwards to minimise the chance of having a stroke. In an emergency, pictures of the heart can be taken to check for blood clots, and cardioversion can be carried out without going on medication first.
Anticoagulation may be stopped if cardioversion is successful. However, you may need to continue taking anticoagulation after cardioversion if the risk of atrial fibrillation returning is high and you have an increased risk of having a stroke (see above).
Catheter ablation is a procedure that very carefully destroys the diseased area of your heart and interrupts abnormal electrical circuits. It's an option if medication hasn't been effective or tolerated.
Catheters (thin, soft wires) are guided through one of your veins into your heart, where they record electrical activity. When the source of the abnormality is found, an energy source, such as high-frequency radiowaves that generate heat, is transmitted through one of the catheters to destroy the tissue.
The procedure usually takes two to three hours, so it may be carried out under general anaesthetic (which means you're asleep during the procedure). You should make a quick recovery after having catheter ablation and be able to carry out most of your normal activities the next day. However, you shouldn't lift anything heavy for two weeks, and driving should be avoided for the first two days.
A pacemaker is a small, battery-operated device that's implanted in your chest, just below your collarbone. It's usually used to stop your heart beating too slowly, but in atrial fibrillation it may be used to help your heart beat regularly.
Having a pacemaker fitted is usually a minor surgical procedure carried out under a local anaesthetic (the area being operated on is numbed and you are awake during the procedure). This treatment may be used when medicines aren't effective or are unsuitable. This tends to be in people aged 80 or over.
Read more about pacemaker implantation.
If you're overweight or obese (you have a body mass index (BMI) of 30 or over), you should lose weight, by gradually by reducing your calorie intake and becoming more physically active (see below).
Losing 5-10% of your overall body weight over the course of a year is a realistic initial target. You should aim to continue to lose weight until you've achieved and maintained a BMI within the healthy range, which is:
- 18.5-24.9kg/m² for the general population
- 18.5-22.9kg/m² for people of south Asian or Chinese origin ('south Asian' means Bangladesh, Bhutan, India, Indian-Caribbean, Maldives, Nepal, Pakistan and Sri Lanka)
If you have a BMI of 30kg/m² or more (27.5kg/m² or more for people of south Asian or Chinese origin), you need a structured weight loss programme, which should form part of an intensive lifestyle change programme.
To help you achieve changes in your behaviour, you may be referred to a dietitician or a similar healthcare professional for a personal assessment and tailored advice about diet and physical activity.
Being physically active is very important in preventing or managing type 2 diabetes.
For adults who are 19-64 years of age, the government recommends aminimum of:
- 150 minutes (2 hours and 30 minutes) of "moderate-intensity"aerobic activity – such as cycling or fast walking – a week, which can be taken in sessions of 10 minutes or more, and
- muscle-strengthening activities on two or more days a week that work all major muscle groups (legs, hips, back, tummy (abdomen), chest, shoulders and arms)
An alternative recommendation is to do a minimum of:
- 75 minutes of "vigorous-intensity" aerobic activity, such asrunning or a game of tennis every week, and
- muscle-strengthening activities on two or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders and arms)
Read more about the physical activity guidelines for adults.
In cases where the above activity levels are unrealistic, even small increases in physical activity will be beneficial to your health and act as a basis for future improvements.
Reduce the amount of time spent watching television or sitting in front of a computer. Going for a daily walk – for example, during your lunch break – is a good way of introducing regular physical activity into your schedule.
If you're overweight or obese (see above), you may need to be more physically active to help you lose weight and maintain weight loss.
Blood pressure and pulse rate:
We check for higher-than-normal blood pressure (hypertension) as this means that the heart has to work harder to push blood around your body. Over the long term, this is associated with an increased risk of heart attack, stroke and kidney disease.
Resting Electrocardiogram (ECG):
This measures the electrical activity of the heart at rest. An electrocardiogram can help to identify problems such thickening of heart muscle, coronary artery disease or electrical disturbance of heart rhythm.
Carotid Duplex Scan
Knowing your risk factors and living healthfully are the best things you can do to prevent a TIA. Included in a healthy lifestyle are regular medical checkups. Also:
- Don't smoke. Stopping smoking reduces your risk of a TIA or a stroke.
- Limit cholesterol and fat. Cutting back on cholesterol and fat, especially saturated fat and trans fat, in your diet may reduce buildup of plaques in your arteries.
- Eat plenty of fruits and vegetables. These foods contain nutrients such as potassium, folate and antioxidants, which may protect against a TIA or a stroke.
- Limit sodium. If you have high blood pressure, avoiding salty foods and not adding salt to food may reduce your blood pressure. Avoiding salt may not prevent hypertension, but excess sodium may increase blood pressure in people who are sensitive to sodium.
- Exercise regularly. If you have high blood pressure, regular exercise is one of the few ways you can lower your blood pressure without drugs.
- Limit alcohol intake. Drink alcohol in moderation, if at all. The recommended limit is no more than one drink daily for women and two a day for men.
- Maintain a healthy weight. Being overweight contributes to other risk factors, such as high blood pressure, cardiovascular disease and diabetes. Losing weight with diet and exercise may lower your blood pressure and improve your cholesterol levels.
- Don't use illicit drugs. Drugs such as cocaine are associated with an increased risk of a TIA or a stroke.
- Control diabetes. You can manage diabetes and high blood pressure with diet, exercise, weight control and, when necessary, medication.
Once your doctor has determined the cause of your transient ischemic attack, the goal of treatment is to correct the abnormality and prevent a stroke. Depending on the cause of your TIA, your doctor may prescribe medication to reduce the tendency for blood to clot or may recommend surgery or a balloon procedure (angioplasty).
Doctors use several medications to decrease the likelihood of a stroke after a transient ischemic attack. The medication selected depends on the location, cause, severity and type of TIA. Two frequently prescribed types of drugs are:
- Anti-platelet drugs. These medications make your platelets, one of the circulating blood cell types, less likely to stick together. When blood vessels are injured, sticky platelets begin to form clots, a process completed by clotting proteins in blood plasma.
The most frequently used anti-platelet medication is aspirin. Aspirin is also the least expensive treatment with the fewest potential side effects. An alternative to aspirin is the anti-platelet drug clopidogrel (Plavix).
Your doctor may consider prescribing Aggrenox, a combination of low-dose aspirin and the anti-platelet drug dipyridamole, to reduce blood clotting. The way dipyridamole works is slightly different from aspirin.
- Anticoagulants. These drugs include heparin and warfarin (Coumadin, Jantoven). They affect clotting-system proteins instead of platelet function. Heparin is used for a short time and warfarin over a longer term.
These drugs require careful monitoring. If atrial fibrillation is present, your doctor may prescribe another type of anticoagulant, dabigatran (Pradaxa).
If you have a moderately or severely narrowed neck (carotid) artery, your doctor may suggest carotid endarterectomy (end-ahr-tur-EK-tuh-me). This preventive surgery clears carotid arteries of fatty deposits (atherosclerotic plaques) before another TIA or stroke can occur. An incision is made to open the artery, the plaques are removed, and the artery is closed.
In selected cases, a procedure called carotid angioplasty, or stenting, is an option. This procedure involves using a balloon-like device to open a clogged artery and placing a small wire tube (stent) into the artery to keep it open.
Because a transient ischemic attack is short-lived, your doctor may diagnose a TIA based just on the medical history of the event rather than on anything found during a general physical and neurological examination. To help determine the cause of your TIA and to assess your risk of stroke, your doctor may rely on the following:
- Physical examination and tests. Your doctor may check for risk factors of stroke, including high blood pressure, high cholesterol levels, diabetes and high levels of the amino acid homocysteine.
Your doctor may also use a stethoscope to listen for a whooshing sound (bruit) over your arteries that may indicate atherosclerosis. Or your doctor may observe cholesterol fragments or platelet fragments (emboli) in the tiny blood vessels of your retina at the back of your eye during an eye examination using an ophthalmoscope.
- Carotid ultrasonography. A wand-like device (transducer) sends high-frequency sound waves into your neck. After the sound waves pass through your tissue and back, your doctor can analyze images on a screen to look for narrowing or clotting in the carotid arteries.
- Computerized tomography (CT) scanning. CT scanning of your head uses X-ray beams to assemble a composite 3-D look at your brain.
- Computerized tomography angiography (CTA) scanning.Scanning of the head may also be used to noninvasively evaluate the arteries in your neck and brain. CTA scanning uses X-rays similar to a standard CT scan of the head but may also involve injection of a contrast material into a blood vessel.
- Magnetic resonance imaging (MRI). This procedure, which uses a strong magnetic field, can generate a composite 3-D view of your brain.
- Magnetic resonance angiography (MRA). This is a method of evaluating the arteries in your neck and brain. It uses a strong magnetic field similar to MRI.
- Echocardiography. Your doctor may choose to perform a transthoracic echocardiogram (TTE) or transesophageal echocardiogram (TEE). A TTE involves moving an instrument called a transducer across your chest. The transducer emits sound waves that echo off of different parts of your heart, creating an ultrasound image.
During a TEE, a flexible probe with a transducer built into it is placed in your esophagus — the tube that connects the back of your mouth to your stomach. Because your esophagus is directly behind your heart, clearer, detailed ultrasound images can be created. This allows a better view of some things, such as blood clots, that might not be seen clearly in a traditional echocardiography exam.
- Arteriography. This procedure gives a view of arteries in your brain not normally seen in X-ray imaging. A radiologist inserts a thin, flexible tube (catheter) through a small incision, usually in your groin.
The catheter is manipulated through your major arteries and into your carotid or vertebral artery. Then the radiologist injects a dye through the catheter to provide X-ray images of the arteries in your brain. This procedure may be used in selected cases.