Recognizing Ischemic Stroke Victims, Cardiac Arrest in Athletes, West Nile Virus

By Mary Jane Dittmar

In the never-ending quest to lower the number of deaths from cardiovascular events for first responders and the overall population of the United States, we continue to search for ways to prevent and to treat these conditions more effectively.  One of this column’s objectives is to present information that could possibly bring us closer to these goals by presenting more “clues.”

Important to Recognize Stroke Symptoms Immediately

Treating an ischemic stroke victim as quickly as possible is crucial. The only approved treatment in the acute setting is administering recombinant tissue plasminogen activator (rt-PA) to break down the blood clot. The optimal time period for administration of rt-PA to achieve maximum efficacy and safety has been firmly established to be within three hours of symptom onset. The benefits of rt-PA are thought to diminish with time. Having patients in the pre-hospital setting ready to receive this treatment within the three-hour time period, however, has been challenging. The medical community, therefore, has been working to expand the three-hour time span. New evidence recently has shown “a modest statistical improvement” in selected patients treated with rt-PA within four and a half hours. It is hoped that more patients will be able to receive this treatment within the optimal time limit.

In view of this time crunch, it is critical that we immediately recognize when someone might be having a stroke so that medical help may be obtained in time for the patient to gain the maximum benefit from treatment.

Pub US National Library of Medicine National Institutes of Health Curr Neurol Neurosci Rep. 2010 Jan; 10(1):29-33. Stemer A, Lyden P.University of California, San Diego, Medical Office North, Third Floor, Suite 3, 200 West Arbor Drive, #8466, San Diego, CA, 92103, USA.

To this end, I am passing along information I received recently in one of those widely distributed e-mails (which many of us sometimes look upon as time and space wasters. This message survived deletion because it may help to save a life. It presents a simple and easy-to-remember way to recognize when someone might be having a stroke. Its contents follow.

You can recognize a stroke by doing the following:

S *Ask the person to SMILE.

T *Ask the person to TALK and SPEAK A SIMPLE SENTENCE coherently—e.g., It is sunny out today.

R *Ask the person to RAISE BOTH ARMS.

T * Ask the person to STICK OUT HIS/HER TONGUE.

A “crooked” tongue that goes to one side or the other is also an indication of a stroke. This is the stroke sign most recently identified.

If the person has trouble with ANY ONE of these tasks, call 911 immediately and describe the symptoms to the dispatcher.

Note: I met a friend last week who told me she was in the hospital for treatment of a “stroke.” She had just returned from dinner with some friends and was sitting with them at home conversing when, unbeknownst to her, she starting to slur her words and talk unintelligibly. The people around her asked if she was okay. She said she was. She told me “she didn’t feel anything.” Her daughter, among the group, called 911 without telling her mother. My friend was transported to the hospital and admitted. She was told she had had a TIA, a transient ischemic attack, also called a “mini stroke.” A TIA is also caused by a clot that blocks the blood supply to part of the brain, but the blockage lasts for a short time, and there is no permanent damage. (“Transient Ischemic Attack (TIA),, accessed Aug. 20, 2010.   It could be a warning that a more serious stroke may occur. After two days of observation and treatment, my friend was prescribed medication and released. It was determined that she had some blockage in one of her carotid arteries. She will now be monitored by her doctor.


Athletes and Cardiac Problems

Sometimes, we hear of athletes and “healthy people in good physical condition” who are stricken with cardiac attacks, sometimes while engaged in exercise. Melissa Marks, president of HealthEdSolutions, says these athletes may suffer from conditions, such as the following, to which healthcare providers and first responders must be able to respond to quickly and skillfully.

Sudden cardiac death. It can be caused by several heart conditions that go undetected. Hypertrophic cardiomyopathy is the most common cause among young athletes. The American Heart Association says that one out of every 30,000 to 50,000 of the more than 7 million U.S. high school athletes dies annually from out-of-hospital sudden cardiac arrest. One death occurs among roughly every 44,000 National College Athletic Association athletes– an average of nine a year–according to University of Washington researchers. Some estimates run from about 66 deaths to more than 100 deaths a year among athletes under the age of 40.

Arrhythmia. Intense physical training may make an individual more prone to developing an arrhythmia. Individuals should seek medical attention when they notice an irregular heartbeat. Certain arrhythmias can lead to serious problems such as a stroke.

High blood pressure. This condition, commonly seen in athletes, might not be harmful to competing athletes, as long as it is controlled through medication or lifestyle changes. If uncontrolled, it can lead to damage of the eyes, kidneys, and heart.

Health Education Solutions (HES), a subsidiary of Nelnet Inc., offers healthcare courses in partnership with the medical faculty at Union College in Lincoln, Nebraska.

“Toll of sudden cardiac arrest,” Los Angeles Times, “Perhaps new athlete-death stats will prompt new look at screening costs,” Marissa Cevallos, HealthKey, Apr. 5, 2011;; accessed Aug. 17, 2012. “Cardiac Arrest A Serious Risk for NCAA Athletes,” Aug. 17, 2012.

West Nile Virus Infection

The outbreak of this infection in the United States has been at the highest level since 1999, the year it was first recognized in this country. At the time this was written, the Centers for Disease Control and Prevention (CDC) had been notified of the detection of this infection in 42 states in people, birds, or mosquitoes. Texas, Mississippi, Louisiana, and Oklahoma have seen the greatest number of human cases.  As of August 17, Texas had recorded 465 cases and 17 deaths; Oklahoma, 40 cases and one death; Louisiana, 37 cases and six deaths; and Mississippi, 33 cases and one death. Aerial spraying of insecticides to control the virus-carrying mosquitoes has begun in some sections of the country, particularly parts of Texas.

The CDC says the best way to prevent West Nile virus disease is to avoid mosquito bites. It suggests using insect repellents outdoors; wearing long sleeves and pants during dawn and dusk; installing or repairing screens on windows and doors and using air-conditioning if available; and emptying standing waters in flowerpots, buckets, children’s pools, and other items outside your home.

Photos courtesy of  


MARY JANE DITTMAR is senior associate editor of Fire Engineering and conference manager of FDIC. Before joining the magazine in January 1991, she served as editor of a trade magazine in the health/nutrition market and held various positions in the educational and medical advertising fields. She has a bachelor’s degree in English/journalism and a master’s degree in communication arts.

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