How to recognize signs of a stroke with the acronym BE FAST

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One in six deaths from cardiovascular disease in the United States is due to stroke, and over 100 million people worldwide have had a stroke, which is a leading cause of serious long-term disability.

During American Heart Month (February), the American Heart Association encourages people to focus on their cardiovascular health, which includes stroke prevention.

What causes stroke? What are major risk factors? How is it diagnosed and treated — and why is early diagnosis important? What are signs everyone should be on the lookout for? And what steps can people take to reduce their risk of developing strokes?

To guide us through these questions, I spoke with CNN wellness expert Dr. Leana Wen. She is an emergency physician and adjunct associate professor at George Washington University. Wen previously served as Baltimore’s health commissioner.

CNN: What causes strokes?

Dr. Leana Wen: Strokes, also known as cerebrovascular accidents or “brain attacks,” have two main types. The most common type is ischemic stroke, which is when blood supply to part of the brain is blocked or reduced. This type can happen because of blood clots that block blood vessels or plaques causing blockages by building up in the vessels. Parts of the brain quickly become deprived of oxygen and other key nutrients.

The second type is hemorrhagic stroke. This occurs when an artery in the brain leaks or bursts and causes bleeding in the brain. The blood puts pressure on brain cells and damages them.

Both types of strokes are very serious medical emergencies. Depending on what part of the brain they affect, the individual can experience permanent neurological deficits, such as losing the ability to speak, walk or move their arms. Strokes can also be fatal. In the US, every three minutes and 11 seconds, a person dies from stroke, according to the Centers for Disease Control and Prevention.

CNN: What about a ministroke? Could that be serious, too?

Wen: A ministroke is also known as a transient ischemic attack, or TIA. This event is caused by a blockage to blood vessels going into the brain, just like an ischemic stroke. The difference is that the blockage is short-lived and generally lasts less than an hour. By definition, symptoms should resolve within 24 hours.

However, a TIA can be a warning sign that a full stroke could follow. Individuals who have a TIA are referred to a neurologist for further testing and assessment of risk of future stroke. In addition, when someone first starts experiencing symptoms, it is not possible to distinguish between a TIA and a full stroke, so it’s crucial to seek help right away.

CNN: What are the major stroke risk factors?

Wen: A number of factors increase stroke risk. It may help to think of them in three categories.

First are medical conditions, such as a previous stroke or TIA, high blood pressure, diabetes, high cholesterol, sickle cell disease and obesity. Several heart disorders also increase stroke risk, including coronary artery disease, as well as heart valve defects, atrial fibrillation and congestive heart failure.

Second are lifestyle factors. Tobacco use increases stroke risk, as does high alcohol consumption, low physical activity and diets high in saturated fats and cholesterol.

Third are factors that one should be aware of but that aren’t changeable. Age is a major risk factor: The older you are, the higher the risk of stroke, to the point that the chance of stroke approximately doubles every 10 years after age 55, according to the CDC. In addition, the risk of having a first stroke is nearly twice as high in Black people as for White people, and women are more likely than men to have a stroke, according to the CDC.

CNN: How is stroke diagnosed and treated? And why is early diagnosis important?

Wen: If someone is having symptoms of a stroke, this is an emergency. This person should be immediately brought to the emergency department. There, the patient will be seen right away, and numerous tests will be done. In addition to a physical exam and blood tests, the patient will undergo brain imaging. This workup usually begins with a CT scan and often involves an MRI as well.

Doctors diagnose the stroke through these brain imaging studies. Physicians typically treat ischemic stroke by giving an intravenous medicine that breaks up blood clots. There is a very strict window of time in which this medicine can be given — three hours from the onset of symptoms, although there can be exceptions under specific circumstances. This is why early diagnosis is so important.

Hemorrhagic stroke is treated differently and will depend on the clinical circumstances. An individual who has a leaking aneurysm could have a procedure to block off the aneurysm, for example.

CNN: What are the signs of stroke that everyone should look out for?

Wen: There is a very helpful acronym everyone should know, which is BE FAST.

B is for balance, if the person is having trouble staying on their feet.

E is for eyes, if the person is experiencing double vision, blurry vision or other sudden vision problems.

F is for face, if the person is having a facial droop — this is especially visible if asked to smile.

A is for arm, if one arm appears weaker than the other.

S is for speech, if the person is having slurred speech or difficulty choosing words.

T is for time — emphasizing that this is an emergency. Call 911 immediately. Note the time you encountered the individual and, if you know, the last time the person was at their baseline normal self.

CNN: I had heard of another acronym, which is FAST. Is BE FAST different?

Wen: BE FAST is FAST plus the B for balance and E for eyes. Studies have shown that including these two additional parameters reduces the miss rate of strokes.

I cannot emphasize enough the importance of everyone understanding BE FAST. You may be the first person to recognize a new facial droop or slurred speech on someone you know and love. That prompt recognition is key to getting the right treatment for this medical emergency.

CNN: What steps can people take to reduce their risk of developing strokes?

Wen: If someone has one or more of the medical conditions that increase their risk for stroke, it’s important to treat those symptoms. Keeping high blood pressure and diabetes under control, for instance, will reduce the risk of developing stroke. Individuals who need to be on blood-thinning medications, including aspirin, should take them as prescribed.

The lifestyle factors that help to reduce stroke — exercising, eating less saturated fat and stopping smoking and excessive drinking — are ones that everyone should try to adopt. They also reduce the risks of developing other cardiovascular diseases.

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