Transient Ischemic Attack (TIA)

Topic Overview

What is a transient ischemic attack (TIA)?

Some people call a transient ischemic attack (TIA) a mini-stroke, because the symptoms are like those of a stroke but do not last long. A TIA happens when blood flow to part of the brain is blocked or reduced, often by a blood clot. After a short time, blood flows again and the symptoms go away. With a stroke, the blood flow stays blocked, and the brain has permanent damage.

A TIA is a warning: It means you are likely to have a stroke in the future. If you think you are having a TIA, call 911 . Early treatment can help prevent a stroke. If you think you have had a TIA but your symptoms have gone away, you still need to call your doctor right away.

What are the symptoms?

Symptoms of a TIA are the same as symptoms of a stroke. They may include:

• Sudden numbness, tingling, weakness, or paralysis in your face, arm, or leg, especially on only one side of your body.
• Sudden vision changes.
• Sudden trouble speaking.
• Sudden confusion or trouble understanding simple statements.
• Sudden problems with walking or balance.
• A sudden, severe headache that is different from past headaches.

What causes a transient ischemic attack?

A blood clot is the most common cause of a TIA. Blood clots can be the result of hardening of the arteries (atherosclerosis), heart attack, or abnormal heart rhythms. Brain cells are affected within seconds of the blockage. That causes symptoms in the parts of the body controlled by those cells. Once the clot dissolves, blood flow returns, and the symptoms go away.

Sometimes a TIA is caused by a sharp drop in blood pressure that reduces blood flow to the brain. This is called a "low-flow" TIA. It is not as common as other types.

See a picture of a transient ischemic attack.

What tests do I need after a TIA?

Your doctor will do tests to look at your heart and blood vessels. You may need:

• Tests that show pictures of your brain and blood vessels, such as a CT scan, an MRI, a magnetic resonance angiogram (MRA), or an angiogram.
• A test that uses sound to check your blood flow (Doppler ultrasound).
• An echocardiogram (echo) to check your heart's shape and its blood flow.
• An electrocardiogram (EKG, ECG) to measure your heart rhythm.
• Blood tests, including a complete blood count and a fasting blood test to check for problems that could be causing your symptoms.

Your doctor will also check to see if something else is causing your symptoms.

How is it treated?

Your doctor will start you on medicines to help prevent a stroke. You may need to take several medicines.

If tests show that the blood vessels (carotid arteries) in your neck are too narrow, you may need surgery to open them up (carotid endarterectomy). This can help prevent blood clots that block blood flow to your brain. Another type of surgery is carotid artery stenting. During this surgery, the doctor puts a small tube called a stent inside your carotid artery. This helps keep the artery open. Carotid artery stenting is not as common as endarterectomy.

You can do a lot to reduce your chance of having another TIA or a stroke. Medicines can help, but you may need to make lifestyle changes too.

• Keep your blood pressure and cholesterol under control.
• If you have diabetes, keep your blood sugar in a target range.
• Take a daily aspirin or other medicines, if your doctor advises it.
• Take your medicines just as your doctor says to.
• Eat a heart-healthy diet that includes plenty of fish, fruits, vegetables, beans, high-fiber grains and breads, and olive oil.
• Get plenty of exercise.
• Stay at a healthy weight.
• If you smoke, quit. Avoid secondhand smoke too.
• Limit alcohol. Having more than 1 drink a day (if you are female) or more than 2 drinks a day (if you are male) increases your risk of stroke.
• Avoid getting sick from the flu. Get a flu shot every year.

Frequently Asked Questions

Learning about TIA:	What is a transient ischemic attack (TIA)? What causes a TIA? What increases my risk for a TIA? Can a TIA be prevented? Who is affected by TIAs?
Being diagnosed:	What are the symptoms of a TIA? What tests will I need?
Getting treatment:	What is the treatment for a TIA? What medicines will I need for a TIA? Will I need surgery?
Ongoing concerns:	Will a TIA lead to a stroke?
Living with TIA:	Will I have to make lifestyle changes after a TIA? How can I eat a heart-healthy diet?

Health Tools

Health Tools help you make wise health decisions or take action to improve your health.

	Decision Points focus on key medical care decisions that are important to many health problems.
	Stroke: Should I Have Carotid Endarterectomy?
	Actionsets are designed to help people take an active role in managing a health condition.
	Heart Disease: Eating a Heart-Healthy Diet
	Warfarin: Taking Your Medicine Safely
	Interactive tools are designed to help people determine health risks, ideal weight, target heart rate, and more.
	Interactive Tool: What Is Your Risk for a Stroke if You Have Atrial Fibrillation?

Cause

Blood clots that temporarily block blood flow to the brain are the most common cause of transient ischemic attacks (TIAs). Blood clots may develop for a variety of reasons.

• A blood clot can form in an artery that supplies blood to the brain.
  • Blood clots usually form in arteries damaged by plaque buildup, which is a process called atherosclerosis. See a picture of how high blood pressure damages arteries.
  • Long-standing high blood pressure or diabetes may damage smaller blood vessels in the brain, causing a clot to form within the blood vessels and block blood flow.
• A blood clot can form in another part of the body (often the heart) and travel through the bloodstream to an artery that supplies blood to the brain. For example, clots may form:
  • After a heart attack.
  • As a result of other conditions that alter how blood flows through the heart, such as abnormal heart rhythms (especially atrial fibrillation), heart valve problems, patent foramen ovale, atrial septal defects, or heart failure.

Also, an artery that is partially blocked with plaque can reduce blood flow to the brain and cause symptoms.

Rare causes of blood clots that can cause a TIA include:

• Clumps of bacteria, tumor cells, or air bubbles that move through the bloodstream.
• Conditions that cause blood cells to stick together. For example, having too many red blood cells (polycythemia), abnormal clotting factors, or abnormally shaped red blood cells, such as those caused by sickle cell disease, may cause blood clots to form.
• Inflammation in the blood vessels, which may develop from conditions such as syphilis, tuberculosis, or other inflammatory diseases.
• A head or neck injury that results in damage to blood vessels in the head or neck.
• A tear in the wall of a blood vessel located in the neck.

Symptoms

A TIA is a warning: It means you are likely to have a stroke in the future. If you think you are having a TIA, call 911 . Early treatment can help prevent a stroke. If you think you had a TIA but your symptoms went away, you still need to call your doctor right away.

Symptoms of transient ischemic attacks (TIAs) occur suddenly and are always temporary. They usually go away within 10 to 20 minutes. TIA symptoms are just like stroke symptoms. They vary depending on which part of the brain is affected. Common symptoms of TIA may include:

• Sudden numbness, tingling, weakness, or paralysis in your face, arm, or leg, especially on only one side of your body.
• Sudden vision changes.
• Sudden trouble speaking.
• Sudden confusion or trouble understanding simple statements.
• Sudden problems with walking or balance.
• A sudden, severe headache that is different from past headaches.

What Happens

Symptoms of a transient ischemic attack (TIA) usually go away within 10 to 20 minutes, but some can last longer. If symptoms last longer than an hour, it might be more likely that you have had a stroke.

TIA symptoms, which are caused by a blood clot that temporarily reduces blood flow to the brain, disappear when the blood clot dissolves and blood flow returns.

A TIA is a warning sign that a stroke may soon follow. Any symptoms of a TIA need to be treated as an emergency.

• After a TIA, 3 to 17 out of 100 people will have a stroke in less than 90 days. The risk of stroke is highest in the first 30 days after a TIA.¹
• Out of those people who have a stroke after a TIA, half have a stroke less than 48 hours after the TIA.¹

A TIA also may signal an increased risk for a heart attack. Atherosclerosis, which is hardening of the arteries, affects blood vessels throughout the body, including arteries that supply blood to the heart and brain. Atherosclerosis that affects the blood vessels in the heart (coronary arteries) may cause chest pain or a heart attack.

What Increases Your Risk

The risk factors for a transient ischemic attack (TIA) are the same as those for a stroke.

Risk factors you can change

Risk factors for TIA that you can change are:

• High blood pressure.
• Smoking and regular exposure to secondhand smoke, which are strong risk factors for stroke, TIA, and heart attack.
• High cholesterol and high triglycerides.
• Excessive use of alcohol.
• Use of birth control pills, especially in women who smoke or have a history of blood clots.
• Being overweight.
• Lack of exercise.
• Illegal drug use (such as a stimulant, like cocaine).

Risk factors you cannot change

Risk factors for TIA that you cannot change are:

• Age: Most TIAs happen after the age of 60.
• Family history: People with a family history of TIA or stroke are at higher risk.
• Prior history of TIA: People who have had a TIA are more likely to have another TIA or a stroke.

Diseases that increase the risk for TIA

Your risk for TIA increases if you have diseases such as:

• High blood pressure.
• High cholesterol.
• Diabetes.
• Hardening of the arteries (atherosclerosis), especially of the carotid arteries.
• Atrial fibrillation and certain other heart conditions, such as coronary artery disease, heart failure, or heart valve disorders.
• Conditions that cause blood cells to stick together and form clots, such as having too many red blood cells (polycythemia), abnormal clotting factors, or abnormally shaped red blood cells, such as those caused by sickle cell disease.

When To Call a Doctor

Call 911 or other emergency services immediately if you have:

• Sudden numbness, tingling, weakness, or paralysis in your face, arm, or leg, especially on only one side of your body.
• Sudden vision changes.
• Sudden trouble speaking.
• Sudden confusion or trouble understanding simple statements.
• Sudden problems with walking or balance.
• A sudden, severe headache that is different from past headaches.

Call your doctor immediately if you have:

• Recently had symptoms of a transient ischemic attack (TIA), even if the symptoms have completely disappeared.
• Had a TIA or stroke while taking aspirin or other medicine that prevents blood clots, and you notice any signs of bleeding.

Call your doctor today if you think you have had a TIA in the past and have not yet talked with your doctor about your symptoms.

Watchful Waiting

Taking a wait-and-see approach, called watchful waiting, is not appropriate if you are having symptoms of a TIA. Any symptoms of a TIA need to be considered a medical emergency. Seek medical assistance immediately.

Who To See

The following doctors can diagnose and treat a transient ischemic attack (TIA):

• Family medicine doctor
• Neurologist
• Emergency medicine specialist
• Internist

Other specialist(s) may be consulted if you need surgery or have other health problems:

• Neurosurgeon
• Cardiologist
• Vascular surgeon (one who specializes in surgery of the blood vessels)

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Immediate evaluation is recommended if you have had or are having a transient ischemic attack (TIA). The purpose of evaluation is to:

• Check for another cause of your symptoms, such as a stroke, low blood sugar (if you have diabetes), or Bell's palsy.
• Look for a blood clot.
• Find out whether you need surgery to reopen a blocked artery (carotid endarterectomy).
• Find out whether you need medicines to prevent blood clots.

If your TIA symptoms have completely disappeared, the results of a physical exam will be normal, and the diagnosis of a TIA usually will be based on your medical history and certain tests.

If a TIA is suspected, the doctor may want to do tests, such as a:

• CT scan of the head, to check for bleeding in the brain when symptoms of a TIA are occurring and to check for evidence of a stroke or other disease, such as a tumor.
• MRI scan, to check for damage to the brain from a stroke.

Further tests are often done to identify the cause of the TIA. If blockage of the carotid arteries is suspected, you may have tests such as:

• A Doppler ultrasound.
• A magnetic resonance angiogram (MRA). See a picture of a TIA angiogram.
• An angiogram of your head and neck.

TIA symptoms may be due to blood clots caused by a heart problem. If heart problems are suspected, you may have tests such as a:

• Chest X-ray to assess the size and shape of your heart.
• Electrocardiogram (ECG, EKG) or Holter monitoring or ambulatory EKG to assess heart rhythm.
• Echocardiogram (echo) to examine the shape of the heart chambers and blood flow through them.
• Cholesterol and triglycerides tests to check the level of these blood fats that can increase your risk for blood clots and hardening of the arteries.

You may have other blood tests, such as a complete blood count (CBC), chemistry screen, and prothrombin time based on your age and medical history. Your doctor will use these tests to look for other causes of the TIA.

Treatment Overview

If you have had a transient ischemic attack (TIA), you will probably need to take a medicine to help prevent blood clots. If the carotid arteries in your neck are significantly blocked, you may also need to have surgery to reopen the narrowed arteries. Also, if you have high blood pressure, diabetes, or high cholesterol, you will also need treatment for those diseases.

Initial treatment

If you have symptoms of a transient ischemic attack (TIA), seek medical help immediately. If you had symptoms of a TIA but you feel better now, you still need to see a doctor right away. A TIA is a sign that a stroke may soon follow, and prompt medical treatment may prevent a stroke. After a TIA, 3 to 17 out of 100 people will have a stroke within 90 days. The risk of stroke is highest in the first 30 days after a TIA. And of the people who have a stroke after a TIA, half have a stroke less than 48 hours after the TIA.¹

You will need to take medicine that will reduce the risk of future blood clots. These medicines may include aspirin, clopidogrel, dipyridamole with aspirin, or warfarin.

If your carotid arteries are significantly blocked, you may need surgery to reopen the narrowed arteries (carotid endarterectomy). For more information about this surgery, see:

Stroke: Should I Have Carotid Endarterectomy?

Ongoing treatment

Ongoing treatment will focus on preventing another transient ischemic attack (TIA) or stroke and reducing additional risk factors for stroke. This may include:

• Reducing high blood pressure, the most common risk factor for stroke, by making changes to your diet and taking blood pressure–lowering medicines.
• Taking aspirin or another antiplatelet medicine to prevent strokes. It has been shown that people who have had a stroke, a TIA, or an endarterectomy may benefit from taking aspirin or another antiplatelet medicine, such as aspirin with extended-release dipyridamole, daily to prevent another stroke.
• Taking an anticoagulant medicine, which is commonly called a blood thinner, if you have atrial fibrillation.
• Taking statins. Statins can reduce the risk of stroke in people who have had a TIA. Statins even protect against stroke in people who do not have heart disease or high cholesterol.²
• Controlling diabetes. Your doctor will advise that you try to keep your blood sugar levels in a target range. To do this, you may need to take oral medicines or insulin. Eating a healthy diet and getting plenty of exercise will also help.
• Getting a flu shot every year to help you avoid getting sick from the flu.

You may also need to make lifestyle changes such as:

• Quitting smoking and avoiding secondhand smoke. People who smoke have a higher risk of stroke than those who quit. Stop-smoking programs, medicines, and counseling can boost your chances of quitting for good.
• Maintaining a healthy weight. Being overweight increases your risk of developing high blood pressure, heart problems, and diabetes, which are risk factors for TIA and stroke.
• Eating a balanced diet that is low in cholesterol, saturated fats, and salt. Fatty foods may make hardening of the arteries worse. Increase fruits and vegetables in your diet. For more information, see:

  Heart Disease: Eating a Heart-Healthy Diet.

• Getting regular exercise. Physical activity significantly lowers your risk of stroke. Do activities that raise your heart rate. Try to do moderate activity, such as brisk walking, at least 2½ hours a week. One way to do this is to be active 30 minutes a day, at least 5 days a week. It's fine to be active in blocks of 10 minutes or more throughout your day and week.
• Limiting alcohol. If you drink alcohol, drink moderately. Moderate drinking is 2 drinks a day for men and 1 drink a day for women. Excessive use of alcohol can raise your risk of stroke.

If you take an anticoagulant, also called a blood thinner, you need to take extra steps to avoid bleeding problems, such as preventing falls and injuries. If you take warfarin, you also need to get regular blood tests and watch how much vitamin K you eat or drink. For more information about safety with warfarin, see:

Warfarin: Taking Your Medicine Safely.

Treatment if the condition gets worse

If you have more than one transient ischemic attack (TIA) close together (a cluster of TIAs), you may be hospitalized because of the increased risk for stroke.

Emergency treatment for stroke is most effective when it is given right away after symptoms begin.

For more information, see the topic Stroke.

What To Think About

After you have an initial evaluation for a TIA, you may need further testing and treatment on an outpatient basis. But because of the increased risk of stroke, staying in the hospital may be recommended for:

• People who have had more than one TIA close together (a cluster of TIAs).
• People who have had TIAs because of a heart condition, such as atrial fibrillation.
• Those who have symptoms that indicate that a large area of the brain is affected.
• Those whose symptoms last longer than an hour.
• Older adults and those with significant risk factors for stroke, such as high blood pressure, diabetes, and heart disease.

Prevention

You can help prevent a transient ischemic attack (TIA) by controlling your risk factors for stroke.

• Have regular medical checkups. Work with your doctor to control high blood pressure, high cholesterol, heart disease (especially atrial fibrillation), diabetes, and disorders that affect blood vessels and how your blood clots, such as polycythemia and sickle cell anemia.
• Quit smoking. Daily cigarette smoking can increase the risk of stroke by 2½ times.³ Regular exposure to secondhand smoke also increases your risk of stroke.
• Stay at a healthy weight. Being overweight increases your risk for high blood pressure, heart problems, and diabetes, which are risk factors for TIA and stroke.
• Eat a balanced diet that is low in cholesterol, saturated fats, and salt. Eat a variety of fruits and vegetables. Fatty foods may make hardening of the arteries worse. For more information, see:

  Heart Disease: Eating a Heart-Healthy Diet.

• Get regular exercise, and reduce your stress. Do activities that raise your heart rate. Try to do moderate activity at least 2½ hours a week. One way to do this is to be active 30 minutes a day, at least 5 days a week.
• Limit alcohol. If you drink alcohol, drink moderately. Moderate drinking is 2 drinks a day for men and 1 drink a day for women. Excessive use of alcohol can raise your risk of stroke.
• Avoid taking birth control pills (oral contraceptives) if you have other risk factors for TIA or stroke, such as smoking, high cholesterol, or a history of blood clots. Talk to your doctor about other forms of birth control that do not increase your risk of TIA and stroke.
• Avoid getting sick from the flu. Get a flu shot every year.

Because atrial fibrillation increases your risk of stroke and because many people do not have symptoms of atrial fibrillation, the National Stroke Association recommends that everyone, particularly those age 55 or older, check his or her heartbeat once a month. To learn how to check your pulse, see taking your pulse. If you notice that your heartbeat does not have a regular rhythm, talk to your doctor.

If you are age 55 or older and have atrial fibrillation, you can check your risk of stroke by using the Interactive Tool: Stroke Risk From Atrial Fibrillation.

Home Treatment

Home treatment is not appropriate for a transient ischemic attack (TIA). If you think you are having a TIA, do not ignore the symptoms and do not try to manage them at home. If you had symptoms of a TIA but they went away, you still need to see a doctor right away. Seek emergency medical care when symptoms first appear. Prompt treatment may keep you from having a stroke.

If you have had a TIA recently:

• Follow your treatment plan to help prevent another TIA or stroke.
• Work with your doctor to control any medical conditions that may increase your risk of having another TIA or stroke, such as high blood pressure, atrial fibrillation, high cholesterol, or diabetes.
• Eat a healthy, balanced diet. For more information, see:

  Heart Disease: Eating a Heart-Healthy Diet.

• Stay at a healthy weight.
• Do not smoke. (For more information on how to quit, see the topic Quitting Smoking.) Avoid secondhand smoke too.
• Get regular exercise.
• Limit alcohol. If you drink alcohol, drink moderately. Moderate drinking is 2 drinks a day for men and 1 drink a day for women.
• Call your doctor if you notice unusual bruising or bleeding and you are taking aspirin or other medicines that slow blood clotting. If you take an anticoagulant, also called a blood thinner, you need to take extra steps to avoid bleeding problems, such as preventing falls and injuries. If you take warfarin, you also need to get regular blood tests and watch how much vitamin K you eat or drink. For more information about safety with warfarin, see:

  Warfarin: Taking Your Medicine Safely.

• Avoid getting sick from the flu. Get a flu shot every year.

Medications

Your doctor will probably prescribe several medicines after you have had a transient ischemic attack (TIA). Medicines to prevent blood clots are typically used, because blood clots can cause TIAs and strokes.

The types of medicines that prevent clotting are:

• Antiplatelet medicines.
• Anticoagulant medicines.

Cholesterol-lowering and blood pressure-lowering medicines are also used to prevent TIAs and strokes.

Antiplatelet medicines

Antiplatelets (such as aspirin, aspirin with extended-release dipyridamole, or clopidogrel) keep platelets in the blood from sticking together.

• Aspirin is most often used to prevent TIAs and strokes. Many studies have shown that aspirin helps prevent strokes and reduces the risk of another TIA in people who have had their first TIA.
• Aggrenox, a medicine that combines aspirin with dipyridamole, is a safe and effective alternative to aspirin to prevent TIA and stroke for some people.⁴
• Other antiplatelet medicines (such as clopidogrel) may be used for people who cannot take aspirin or for whom aspirin has not been effective.

Anticoagulants

Anticoagulant medicines, also called blood thinners, prevent blood clots from forming and keep existing blood clots from getting bigger. If you have atrial fibrillation, you will probably take an anticoagulant such as warfarin (for example, Coumadin). For more information, see the topic Atrial Fibrillation.

Statins

Statins lower cholesterol and can greatly reduce the risk of stroke in people who have had a TIA. Statins even protect against stroke in people who do not have heart disease or high cholesterol.²

Blood pressure medicines

If you have high blood pressure, your doctor may want you to take medicines to lower it. Blood pressure medicines include:

• Angiotensin II receptor blockers (ARBs).
• Angiotensin-converting enzyme (ACE) inhibitors.
• Beta-blockers.
• Calcium channel blockers.
• Diuretics.

Surgery

If you have significant blockage in the carotid arteries in your neck, you may need a carotid endarterectomy. During this surgical procedure, a surgeon removes plaque buildup in the carotid arteries to reduce the risk of transient ischemic attack (TIA) or stroke. The benefits and risks of this surgery must be carefully weighed, because the surgery itself may cause a stroke. Your need to have carotid endarterectomy depends on whether you have had a TIA and how much your carotid arteries have narrowed.

Stroke: Should I Have Carotid Endarterectomy?

You are most likely to benefit from surgery if you have had a TIA in the past 6 months and you have 70% or greater narrowing in one of your carotid arteries. Carotid endarterectomy may also be appropriate if your carotid arteries are moderately or severely blocked (50% to 70%) and you have had one or more TIAs.⁵ Talk to your doctor about whether a carotid endarterectomy is right for you.

Each person must carefully weigh the benefits and risks of surgery and compare them with the benefits and risks of using medicine to reduce the risk of TIA or stroke. The success of either treatment will depend on the amount of blockage you have and which medicine you use. Risks of surgery depend on your age, your health status, the skill and experience of the surgeon, and the experience of the medical center where the surgery is done.

Surgery Choices

Carotid Endarterectomy

What To Think About

Carotid endarterectomies are most successful when they are done by a surgeon who is well trained in the procedure and in a hospital that is well equipped to take care of any complications that may occur during or after the procedure.

If you are considering carotid endarterectomy, ask the hospital or state medical board about the number of times complications have occurred in people that your doctor has treated with this surgery and the complication rate at the hospital where the surgery is to be done. The American Heart Association Stroke Council recommends that surgery be done by a surgeon who has complications in less than 3% of those treated and that the hospital rate of complications be just as low.⁵

Carotid endarterectomy is often not done until several months after a TIA, but a large study showed that people benefit most from the surgery if it is done within 2 weeks of a TIA. Delaying surgery longer than 2 weeks increases the risk for stroke, because a person is more likely to have a stroke in the first few days and weeks after a TIA. These results also point out why it is so important to see a doctor immediately if you have any signs of TIA.⁶

Other Treatment

Carotid artery stenting is a procedure similar to one commonly used to open narrowed arteries in the heart. Angioplasty combined with a stent is now being done as an alternative to surgery for preventing transient ischemic attack (TIA) or stroke. In this procedure, a doctor threads a thin tube called a catheter through an artery in the groin and up to the carotid arteries in your neck. The doctor then uses a tiny balloon to enlarge the narrowed portion of the artery and places a wire mesh stent to keep the artery open. Carotid artery stenting is not as common as carotid endarterectomy.

Other Places To Get Help

Organizations

National Institute of Neurological Disorders and Stroke
NIH Neurological Institute
P.O. Box 5801
Bethesda, MD  20824
Phone:	1-800-352-9424
Phone:	(301) 496-5751
TDD:	(301) 468-5981
Web Address:	www.ninds.nih.gov
The National Institute of Neurological Disorders and Stroke (NINDS), a part of the National Institutes of Health, is the leading U.S. federal government agency supporting research on brain and nervous system disorders. It provides the public with educational materials and information about these disorders.
American Heart Association (AHA)
7272 Greenville Avenue
Dallas, TX  75231
Phone:	1-800-AHA-USA1 (1-800-242-8721)
Web Address:	www.heart.org
Visit the American Heart Association (AHA) website for information on physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your nearest local or state AHA group. The AHA provides brochures and information about support groups and community programs, including Mended Hearts, a nationwide organization whose members visit people with heart problems and provide information and support.
National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD  20824-0105
Phone:	(301) 592-8573
Fax:	(240) 629-3246
TDD:	(240) 629-3255
Email:	nhlbiinfo@nhlbi.nih.gov
Web Address:	www.nhlbi.nih.gov
The U.S. National Heart, Lung, and Blood Institute (NHLBI) information center offers information and publications about preventing and treating: Diseases affecting the heart and circulation, such as heart attacks, high cholesterol, high blood pressure, peripheral artery disease, and heart problems present at birth (congenital heart diseases). Diseases that affect the lungs, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema, sleep apnea, and pneumonia. Diseases that affect the blood, such as anemia, hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.
National Stroke Association
9707 East Easter Lane, Building B
Centennial, CO  80112
Phone:	1-800-STROKES (1-800-787-6537)
Fax:	(303) 649-1328
Email:	info@stroke.org
Web Address:	www.stroke.org
This association provides education, information, referrals, and research on stroke. Information specific to survivors, caregivers, family, women, and children is included.

Related Information

• Atrial Fibrillation
• Coronary Artery Disease
• Healthy Eating
• High Blood Pressure
• High Cholesterol
• Quitting Smoking
• Sickle Cell Disease
• Stroke
• Type 2 Diabetes: Living With the Disease
• Weight Management

References

Citations

1. Lloyd-Jones D, et al. (2009). Heart disease and stroke statistics 2010 update: A report from the American Heart Association. Circulation. Published online December 17, 2009 (doi: 10.1161/circulationaha.109.192667). Also available online: http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.109.192667.

2. Adams RJ (2008). AHA/ASA science advisory: Update to the AHA/ASA recommendations for the prevention of stroke in patients with stroke and transient ischemic attack. Stroke, 39(5): 1647–1652.

3. Kasner SE, Moss HE (2008). Cerebrovascular disorders. In EG Nabel ed., ACP Medicine, section 11, chap. 4. Hamilton, ON: BC Decker.

4. ESPRIT Study Group (2006). Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): A randomized controlled trial. Lancet, 367(9523): 1665–1673.

5. Biller J, et al. (1998). Guidelines for carotid endarterectomy: A statement for healthcare professionals from a special writing group of the Stroke Council of the American Heart Association. Circulation, 97(5): 501–509.

6. Rothwell PM, et al., (2004). Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet, 363(9413): 915–924.

Other Works Consulted

• Easton JD, et al. (2009). Definition and evaluation of transient ischemic attack: A scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. Stroke, 40(6): 2276–2293. Also available online: http://stroke.ahajournals.org/cgi/reprint/40/6/2276.

• Goldstein LB, et al. (2006). Primary prevention of ischemic stroke: A guideline from the American Heart Association/American Stroke Association Stroke Council. Stroke, 37(6): 1583–1633.

• Rothwell PM, et al. (2007). Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): A prospective population-based sequential comparison. Lancet, 370(9596): 1432–1442.

• Sacco RL, et al. (2006). Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack. Stroke, 37(2): 577–617.

• Skinner JS, Cooper A (2009). Secondary prevention of ischaemic cardiac events, search date October 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.

• Smith SC, et al. (2006). AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: Endorsed by the National Heart, Lung, and Blood Institute. Circulation, 113(19): 2363–2372. [Erratum in Circulation, 113(22): 847.]

• U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/pdf/paguide.pdf.

Credits

By	Healthwise Staff
Primary Medical Reviewer	E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer	Richard D. Zorowitz, MD - Physical Medicine and Rehabilitation
Last Revised	January 31, 2011

By:	Healthwise Staff	Last Revised: January 31, 2011
Medical Review:	E. Gregory Thompson, MD - Internal Medicine Richard D. Zorowitz, MD - Physical Medicine and Rehabilitation
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