A 73-year-old man with chronic atrial fibrillation and a history of myocardial infarction presents with acute onset of severe left leg pain and pallor. Vital signs show HR 110 bpm (irregular), BP 138/82, RR 18, temp 37.2°C. Physical examination reveals the left foot is cool and pulseless below the knee with diminished sensation. ECG demonstrates atrial fibrillation. Doppler ultrasound shows acute arterial occlusion. He denies recent trauma. Which structure is the most likely source of the occluding embolus?
- A)Thrombus in the superior vena cava
- B)Vegetation on the tricuspid valve
- C)Atheromatous plaque from the pulmonary artery
- D)Deep venous thrombosis in the calf
- E)Mural thrombus in the left atriumGABARITO
Explicação
Mural thrombus in the left atrium is correct. Atrial fibrillation predisposes to thrombus formation in the left atrium, particularly the appendage, and these emboli can travel into the systemic arterial circulation causing acute limb ischemia. The sudden onset... Ver explicação completa e trilha adaptativa →