Journal article
Embolic Strokes in Paroxysmal Atrial Fibrillation: Anticoagulation Failure or Something Else?
Curēus (Palo Alto, CA), v 16(4), pe57741
06 Apr 2024
PMID: 38715991
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Infective endocarditis (IE) often presents with various signs and/or symptoms. However, at times, IE can present without outstanding clinical evidence but may carry devastating consequences if not detected and treated. We present a case of an 81-year-old female with paroxysmal atrial fibrillation who presented to the was one, and her physical examination was unremarkable. Brain imaging revealed bilateral multiple acute supratentorial and infratentorial infarcts. The patient was fully compliant on apixaban and had a dualchamber pacemaker placed years earlier at an outside facility for unclear reasons. Although initially suspected to have experienced anticoagulation failure (ACF), transesophageal echocardiography (TEE) was ordered to evaluate for possible left atrial appendage closure procedure, which disclosed a mobile, echobright structure on the mitral valve consistent with IE. Blood cultures returned positive, the patient was treated with IV antibiotics, and apixaban was resumed. It can be challenging to suspect IE clinically, especially in deceptive or insidious cases with no signs/symptoms. Still, ACF is a diagnosis of exclusion, and all sources of embolic stroke (such as IE) must be thoroughly worked up before assuming treatment failure.
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Details
- Title
- Embolic Strokes in Paroxysmal Atrial Fibrillation: Anticoagulation Failure or Something Else?
- Creators
- Muhammad Umer Riaz Gondal - Drexel UniversityJohn Lemoine - Reading HospitalMuhammad Asad Hanif - Reading HospitalNayab Mirza - Reading HospitalShuaib Latif - Reading Hospital
- Publication Details
- Curēus (Palo Alto, CA), v 16(4), pe57741
- Publisher
- Springer Nature
- Number of pages
- 4
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- General Internal Medicine
- Web of Science ID
- WOS:001209309700013
- Other Identifier
- 991022193968404721
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- Web of Science research areas
- Medicine, General & Internal