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Related Experiment Videos

Paradoxical embolism. An underrecognized problem

R Ward1, D Jones, E F Haponik

  • 1Section on Pulmonary and Critical Care Medicine, Bowman Gray School of Medicine, Winston-Salem, NC, USA.

Chest
|August 1, 1995
PubMed
Summary

Paradoxical embolus (PDE) is often missed despite its serious arterial occlusion consequences. High suspicion for PDE is crucial in unexplained arterial events, especially with patent foramen ovale (PFO).

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Area of Science:

  • Cardiology
  • Neurology
  • Vascular Medicine

Background:

  • Paradoxical embolus (PDE) remains a frequently missed diagnosis despite over a century of reports on its clinical presentation and severe outcomes.
  • Patent foramen ovale (PFO) affects 27-35% of the general population, increasing the risk of PDE.
  • Deep vein thrombosis or pulmonary emboli may not be clinically apparent, complicating PDE diagnosis.

Observation:

  • A high index of suspicion for PDE is necessary when encountering unexplained arterial occlusion.
  • Contrast echocardiography and transcranial Doppler ultrasound aid in recognizing PDE.
  • Optimal diagnostic strategies for PDE require further definition.

Findings:

  • Anticoagulation is the primary treatment for PDE.
  • Thrombolytics are reserved for carefully selected PDE patients.
  • Limited data exists on the long-term management and outcomes of PDE.

Implications:

  • Prevention of PDE is paramount.
  • The benefit of prophylactic treatment for individuals with predispositions like PFO and pulmonary hypertension is yet to be determined.
  • Further research is needed to clarify diagnostic and therapeutic guidelines for paradoxical embolus.

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