If you or your loved one has AFib, you’ll need to know the signs of stroke. By using the simple acronym F.A.S.T., you’ll be able to quickly recognize if your loved one may be suffering a stroke. That’s important because it could be a situation where seconds count. Take a few minutes to commit this acronym to memory:

FACE: Ask your loved one to smile. Does one side of his or her face droop?

ARMS: Ask your loved one to raise both arms. Does one arm drift downward?

SPEECH: Ask your loved one to repeat a simple phrase. Does his or her speech sound slurred or strange? (Can't teach an old dog new tricks)

TIME: Time is crucial. Call 9-1-1 immediately if you or your loved one has any of these symptoms.

Hemorrhagic stroke

There are two types of stroke, hemorrhagic and ischemic. Hemorrhagic strokes are less common, in fact only 15 percent of all strokes are hemorrhagic, but they are responsible for about 40 percent of all stroke deaths.

A hemorrhagic stroke is either a brain aneurism burst or a weakened blood vessel leak. Blood spills into or around the brain and creates swelling and pressure, damaging cells and tissue in the brain. There are two types of hemorrhagic stroke called intracerebal and subarachnoid.

Intracerebral Hemorrhage

The most common hemorrhagic stroke happens when a blood vessel inside the brain bursts and leaks blood into surrounding brain tissue (intracerebal hemorrhage). The bleeding causes brain cells to die and the affected part of the brain stops working correctly. High blood pressure and aging blood vessels are the most common causes of this type of stroke.

Sometimes intracerebral hemorrhagic stroke can be caused by an arteriovenous malformation (AVM). AVM is a genetic condition of abnormal connection between arteries and veins and most often occurs in the brain or spine. If AVM occurs in the brain, vessels can break and bleed into the brain.  The cause of AVM is unclear but once diagnosed it can be treated successfully.

Subarachnoid Hemorrhage

This type of stroke involves bleeding in the area between the brain and the tissue covering the brain, known as the subarachnoid space. This type of stroke is most often caused by a burst aneurism. Other causes include:

  • AVM

  • Bleeding disorders

  • Head injury

  • Blood thinners

Ischemic stroke

Ischemic stroke occurs when a blood vessel carrying blood to the brain is blocked by a blood clot. This causes blood not to reach the brain. High blood pressure is the most important risk factor for this type of stroke. Ischemic strokes account for about 87% of all strokes. An ischemic stroke can occur in two ways. 

Embolic Stroke

In an embolic stroke, a blood clot or plaque fragment forms somewhere in the body (usually the heart) and travels to the brain. Once in the brain, the clot travels to a blood vessel small enough to block its passage. The clot lodges there, blocking the blood vessel and causing a stroke. About 15% of embolic strokes occur in people with atrial fibrillation (Afib). The medical word for this type of blood clot is embolus. 

Thrombotic Stroke

A thrombotic stroke is caused by a blood clot that forms inside one of the arteries supplying blood to the brain.  This type of stroke is usually seen in people with high cholesterol levels and atherosclerosis. The medical word for a clot that forms on a blood-vessel deposit is thrombus.

Two types of blood clots can cause thrombotic stroke: large vessel thrombosis and small vessel disease.  

Large Vessel Thrombosis

The most common form of thrombotic stroke (large vessel thrombosis) occurs in the brain’s larger arteries. In most cases it is caused by long-term atherosclerosis in combination with rapid blood clot formation. High cholesterol is a common risk factor for this type of stroke.

Small Vessel Disease

Another form of thrombotic stroke happens when blood flow is blocked to a very small arterial vessel (small vessel disease or lacunar infarction). Little is known about the causes of this type of stroke, but it is closely linked to high blood pressure. 

What is TIA?

When blood flow to part of the brain stops for a short period of time, also called transient ischemic attack (TIA), it can mimic stroke-like symptoms. These symptoms appear and last less than 24 hours before disappearing. While TIAs generally do not cause permanent brain damage, they are a serious warning sign that a stroke may happen in the future and should not be ignored. 

TIA by the numbers

TIAs are usually caused by one of three things:

  • Low blood flow at a narrow part of a major artery carrying blood to the brain, such as the carotid artery.

  • A blood clot in another part of the body (such as the heart) breaks off, travels to the brain, and blocks a blood vessel in the brain.

  • Narrowing of the smaller blood vessel in the brain, blocking blood flow for a short period of time; usually caused by plaque (a fatty substance) build-up.

Some important facts to keep in mind include:

  • 40 percent of people who have a TIA will have an actual stroke

  • Nearly half of all strokes occur within the first few days after a TIA

  • Symptoms for TIA are the same as for a stroke.

During a heart attack, blood flow to heart muscle is reduced or cut off, often because a blood clot blocks an artery. When heart muscle is starved of oxygen-rich blood, it can die.

Ideally, treatment to restore blood flow, such as angioplasty or clot-dissolving drugs, should begin within 1 hour after symptoms begin, the AHA says. The faster you can get to the emergency room, the better your chance of survival. And yet, one study found that half of people with heart attack symptoms delayed seeking help for more than 4 hours.

Familiarize yourself with these heart attack symptoms:

  • Uncomfortable pressure, fullness, squeezing, or pain in the center of the chest. These symptoms can range from mild to severe, and they may come and go.

  • Discomfort in other areas, such as the neck, arms, jaw, back, or stomach.

  • Shortness of breath, lightheadedness, nausea, or breaking out in a cold sweat.

Women may get chest pain or discomfort, but in many cases, it's not the most obvious symptom. Instead, they're more likely than men to have these symptoms:

  • Unusual fatigue

  • Nausea or indigestion

  • Dizziness or lightheadedness

  • Abdominal discomfort that may feel like indigestion

  • Discomfort described as pressure/ tightness or an ache in the neck, shoulder, or upper back

In the weeks before an actual heart attack, some women may get these signs as a warning that an artery is blocked. If you develop unexplained fatigue, shortness of breath, or abdominal pressure that feels like indigestion, call your doctor, says Nieca Goldberg, MD, a cardiologist and chief of Women's Cardiac Care at Lenox Hill Hospital in New York City. "That's the time to come in for an evaluation."

Heart Attack Symptoms: What to Do

If you or someone near you has heart attack symptoms, don't wait for more than 5 minutes to call 911. Have someone else drive you to the emergency room only if you can't call 911 for some reason, experts say. Never drive yourself unless you have no other option.

"People need to understand that 911 gets you into the hospital in a really rapid manner," Daya says. "You bypass a lot of the process in the waiting area and you're immediately taken back."

Calling 911 is best because emergency medical personnel can start treatment, such as oxygen, heart medications, and pain relievers, as soon as they reach you. They can also alert the hospital to begin preparations for tests and treatment.

Before the ambulance arrives, here are other ways to help yourself or someone else having heart attack symptoms:

  • The patient should chew and swallow an aspirin.

  • The patient should stop all activity, lie still, and try to remain calm.

  • If the patient becomes unconscious, stops breathing, and doesn't respond to stimulation, such as shaking, he or she may be in cardiac arrest. In other words, the heart stops beating. If an automated external defibrillator (AED) is on hand, follow instructions on the device and use it immediately. The device can deliver an electrical shock that can restore normal heart rhythm and make the heart beat again. If the heart doesn't start beating, a trained person should begin cardiopulmonary resuscitation (CPR).

  • If the patient becomes unconscious, doesn't have a pulse, or isn't breathing, a trained person should perform CPR. If you're not CPR-trained, a 911 dispatcher may be able to talk you through the steps until help arrives.


A heart attack can be hard to distinguish from angina, which is temporary chest pain or pressure that happens when heart muscle isn't getting enough oxygen. Angina usually occurs because arteries that supply blood and oxygen to the heart have become narrowed or blocked. Strong emotion, physical exertion, hot and cold temperature extremes, or a heavy meal can trigger angina.

Symptoms include:

  • Pressure, pain, squeezing, or a sense of fullness in the center of the chest

  • Pain or discomfort in the shoulder, arm, back, neck, or jaw

If you have stable angina, symptoms usually happen with predictable triggers. They usually stop if you rest or take nitroglycerin that your doctor has prescribed. Follow your doctor's orders for when to call 911. For instance, patients are often instructed to take nitroglycerin pills within a certain amount of time and then call 911 if symptoms don't go away or if they get worse.

If you have unstable angina, the chest pain comes at unexpected times, even with little physical exertion. Symptoms don't go away with rest or medication. It can be hard to distinguish unstable angina from heart attack symptoms. If your chest pain doesn't improve after you've taken nitroglycerin, or if it worsens, call 911.

If you get chest pain for the first time, call 911. If you've never been prescribed nitroglycerin, don't take anyone else's, says Alfred Sacchetti, MD, an emergency physician and spokesman for the American College of Emergency Physicians.


It is normal to have stress reactions after a traumatic event. Your emotions and behavior can change in ways that are upsetting to you. Even though most people have stress reactions following a trauma, they get better in time. But, you should seek help if symptoms:

  • Last longer than three months

  • Cause you great distress

  • Disrupt your work or home life

What are the symptoms of PTSD?

Symptoms of PTSD may disrupt your life and make it hard to continue with your daily activities. You may find it hard just to get through the day.

There are four types of PTSD symptoms:

Memories of the traumatic event can come back at any time. You may feel the same fear and horror you did when the event took place. For example:

  • Reliving the event (also called re-experiencing symptoms)

    • You may have nightmares.

    • You may feel like you are going through the event again. This is called a flashback.

    • You may see, hear, or smell something that causes you to relive the event. This is called a trigger. News reports, seeing an accident, or hearing a car backfire are examples of triggers.

You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event. For example:

The way you think about yourself and others changes because of the trauma. This symptom has many aspects, including the following:

  • Avoiding situations that remind you of the event

    • You may avoid crowds, because they feel dangerous.

    • You may avoid driving if you were in a car accident or if your military convoy was bombed.

    • If you were in an earthquake, you may avoid watching movies about earthquakes.

    • You may keep very busy or avoid seeking help because it keeps you from having to think or talk about the event.

  • Negative changes in beliefs and feelings

    • You may not have positive or loving feelings toward other people and may stay away from relationships.

    • You may forget about parts of the traumatic event or not be able to talk about them.

    • You may think the world is completely dangerous, and no one can be trusted.

You may be jittery, or always alert and on the lookout for danger. You might suddenly become angry or irritable. This is known as hyperarousal. For example:

  • Feeling keyed up (also called hyperarousal)

    • You may have a hard time sleeping.

    • You may have trouble concentrating.

    • You may be startled by a loud noise or surprise.

    • You might want to have your back to a wall in a restaurant or waiting room.

What should I do if I have symptoms of PTSD?

PTSD symptoms usually start soon after the traumatic event. But for some people, they may not happen until months or years after the trauma. Symptoms may come and go over many years. So, you should keep track of your symptoms and talk to someone you trust about them.

If you have symptoms that last longer than four weeks, cause you great distress, or disrupt your work or home life, you probably have PTSD. You should seek professional help from a doctor or counselor.


For more information on PTSD visit the VA website here