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Natural History and Sequelae of Penetrating Aortic Ulcer
A man in his 70s with history of tobacco use and hypertension presented for transesophageal echocardiography after a recent diagnosis of ischemic stroke. This demonstrated a moderate right-to-left shunt on Valsalva release and no left atrial appendage thrombus. Assessment of the thoracic aorta revealed a complex penetrating aortic ulcer and saccular aneurysm with thrombus in the distal arch and proximal descending thoracic aorta (Figure). Computed tomography angiography confirmed the presence of multiple penetrating ulcerations with large saccular aneurysms.
Source: Mayo Clinic Proceedings - September 1, 2023 Category: Internal Medicine Authors: Raghav R. Julakanti, Prabhakar Shantha Rajiah, Krishnaswamy Chandrasekaran Tags: Medical image Source Type: research

Left Atrial Appendage Occlusion, A Misnomer?
The importance of the left atrial appendage (LAA) as the source of thromboembolism including stroke in patients with nonvalvular atrial fibrillation is well documented, with more than 90% of ischemic strokes related to a LAA thrombus. Although oral anticoagulation has been the standard of care, approximately 50% to 60% of patients either have contraindications to oral anticoagulation or do not continue the medication beyond the first year. This led to the development of local site-specific therapy to occlude the LAA by either surgical or transcatheter means.
Source: Mayo Clinic Proceedings - August 1, 2022 Category: Internal Medicine Authors: David R. Holmes, Trevor J. Simard, Ammar M. Killu, Mohamad A. Alkhouli Tags: Review Source Type: research

28-Year-Old Man With Joint Pain
A 28-year-old man presented to the emergency department with right shoulder pain that radiated to the right arm as well as pain of the right hip and lower back. His medical history is significant for sickle cell disease (SCD) with the HbSS genotype (homozygous for the S globin). He had a hemorrhagic stroke in the setting of venous sinus thrombosis 2 years earlier with no persisting neurologic deficits as well as osteonecrosis of bilateral hips and right knee requiring right total hip arthroplasty and right total knee arthroplasty.
Source: Mayo Clinic Proceedings - June 1, 2022 Category: Internal Medicine Authors: Emily B. Butts, Albert Bui, Razvan M. Chirila Tags: Residents ’ clinic Source Type: research

Thromboembolic Risk in Hospitalised and Non-hospitalised Covid-19 Patients: A Self-controlled Case Series Analysis of a Nation-wide Cohort
This study aims to assess the associations between Covid-19 infection and thromboembolism including myocardial infarction (MI), ischaemic stroke, deep-vein thrombosis (DVT), and pulmonary embolism (PE).
Source: Mayo Clinic Proceedings - July 15, 2021 Category: Internal Medicine Authors: Frederick K. Ho, Kenneth KS. Man, Mark Toshner, Colin Church, Carlos Celis-Morales, Ian CK. Wong, Colin Berry, Naveed Sattar, Jill P. Pell Tags: Original Article Source Type: research

Thromboembolic Risk in Hospitalized and Nonhospitalized COVID-19 Patients
To assess the associations between coronavirus disease 2019 (COVID-19) infection and thromboembolism including myocardial infarction (MI), ischemic stroke, deep vein thrombosis (DVT), and pulmonary embolism (PE).
Source: Mayo Clinic Proceedings - July 15, 2021 Category: Internal Medicine Authors: Frederick K. Ho, Kenneth K.C. Man, Mark Toshner, Colin Church, Carlos Celis-Morales, Ian C.K. Wong, Colin Berry, Naveed Sattar, Jill P. Pell Tags: Original article Source Type: research

Stroke Prevention in Very Elderly Patients With Nonvalvular Atrial Fibrillation Revisited
Stroke prevention is the cornerstone in the management of patients with atrial fibrillation (AF). Oral anticoagulation (OAC) has been the main strategy to reduce the risk of thromboembolism in most AF patients.1 However, its effective use is hampered by several challenges, including the attended bleeding risk, noncompliance, and cost.2 Elderly patients are further disadvantaged with additional factors that may limit the use of OAC, such as frailty, polypharmacy, and functional dependence.3 In addition, there are limited data to guide stroke prevention decisions in these patients; octogenarians are typically excluded from c...
Source: Mayo Clinic Proceedings - January 1, 2021 Category: Internal Medicine Authors: Mohamad Alkhouli Tags: Editorial Source Type: research

CHA2DS2-VASc Score: A Predictor of Thromboembolic Events and Mortality in Patients With an Implantable Monitoring Device Without Atrial Fibrillation
To determine if the CHA2DS2-VASc score (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65-74 years, sex category) predicts thromboembolism and death in patients without atrial fibrillation in a population with implantable cardiac monitoring devices.
Source: Mayo Clinic Proceedings - February 28, 2017 Category: Internal Medicine Authors: Christine Parsons, Salma I. Patel, Stephen Cha, Win-Kuang Shen, Santosh Desai, Alanna M. Chamberlain, Sushil Allen Luis, Maria I. Aguilar, Bart M. Demaerschalk, Farouk Mookadam, Fadi Shamoun Tags: Original article Source Type: research