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Aneurysm II: Clinical Manifestations and Diagnostic Studies01:21

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Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
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Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care01:29

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Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
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Acute Coronary Syndrome III: Diagnostic Studies01:30

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Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
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Atherosclerosis II: Clinical Manifestations and Diagnostic Tests01:27

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Atherosclerosis is a progressive disorder that leads to the thickening and narrowing of arterial walls due to plaque buildup. This condition can cause various symptoms depending on the arteries affected:Coronary Artery Disease (CAD): This condition affects the coronary arteries and may lead to chest pain (angina), shortness of breath (dyspnea), heart attacks, and other heart disease symptoms.Cerebrovascular Disease: This affects blood flow to the brain, causing transient ischemic attacks (TIAs)...
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Appendicitis-II: Diagnostic Studies and Management01:29

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Diagnosing and managing appendicitis requires a structured and comprehensive approach that spans from initial assessment to postoperative care. Here is an overview of the process:
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
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Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies01:20

Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies

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The key difference between Superficial Vein Thrombosis (SVT) and Deep Vein Thrombosis (DVT) lies in their location and severity.Clinical ManifestationsSVT typically presents with localized pain, tenderness, and redness along the course of a superficial vein, often accompanied by a palpable, cord-like structure under the skin. This condition is usually less dangerous than DVT but can be uncomfortable and may lead to complications such as cellulitis or, rarely, a clot extension into the deep...
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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Cryptogenic Stroke: Diagnostic Workup and Management.

Brian Mac Grory1, Shane P Flood2, Eirini Apostolidou2

  • 1Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA.

Current Treatment Options in Cardiovascular Medicine
|December 4, 2019
PubMed
Summary
This summary is machine-generated.

Cryptogenic stroke, or embolic stroke of undetermined source (ESUS), may benefit from anticoagulation in specific patient subgroups. Recent trials have yielded mixed results, highlighting the need for further research into targeted therapies for stroke prevention.

Keywords:
Cardiac monitoringCryptogenic strokeEmbolic strokeParoxysmal atrial fibrillationPatent foramen ovale

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Area of Science:

  • Neurology
  • Cardiology
  • Vascular Medicine

Background:

  • Cryptogenic stroke lacks a clear cause despite investigation.
  • Embolic stroke of undetermined source (ESUS) is a proposed subtype of cryptogenic stroke.
  • Potential causes include cardiac lesions, atrial fibrillation, hypercoagulability, and malignancy.

Purpose of the Study:

  • To review the concept of cryptogenic stroke and ESUS.
  • To discuss proposed management pathways for ESUS.
  • To examine recent findings and ongoing clinical trials.

Main Methods:

  • Review of existing literature and clinical trial data.
  • Analysis of post-hoc trial results (WARSS).
  • Discussion of ongoing trials (ARCADIA, ATTICUS).

Main Results:

  • Recent ESUS trials (NAVIGATE-ESUS, RESPECT-ESUS) did not meet primary endpoints.
  • Post-hoc analysis suggests anticoagulation may benefit ESUS patients with elevated pro-BNP.
  • Carotid web is an emerging cause of embolic stroke.
  • Percutaneous closure may reduce recurrent stroke risk in younger ESUS patients with PFO.

Conclusions:

  • ESUS is a precisely defined entity requiring specific workup and implicating embolism.
  • Management options include anti-platelet therapy, empiric anticoagulation, or clinical trial enrollment.
  • Further research is needed to identify subgroups benefiting from anticoagulation.