Log in to MyACC
A Patient With Recent-Onset Ischemic Stroke: When to Suspect AF as the Cause?
A 62-year-old woman presented to the hospital with difficulty speaking and right-sided weakness. She was taken by ambulance to the hospital, where she received tissue plasminogen activator and had a dramatic recovery.
One week post stroke, she is seen in consultation. She has recovered to her baseline function. She does not endorse any symptoms or history of stroke or transient ischemic attacks. She does not describe any cardiac symptoms. There is no history of palpitations. Her medical history is significant for hypertension (HTN), dyslipidemia, diabetes mellitus (DM), and sleep apnea. Her medications include ramipril, hydrochlorothiazide, atorvastatin, aspirin, and metformin. She does not smoke.
Examination findings are unremarkable. Blood pressure is 140/65 mm Hg. Heart rate is 70 bpm and regular. There are no cranial or cervical bruits. Visual fields are full. Ocular movements are full and smooth. Cranial nerves are intact. There is no drift. Tone and power are normal in the upper and lower extremities. Reflexes are symmetric. Cardiopulmonary examination findings are also unremarkable.
A computed tomography (CT) head scan has findings of multiple well-defined infarcts in the right posterior central gyrus, right lateral temporal parietal region, medial right parietal occipital region, posterior lateral right cerebellar hemisphere, and left temporal occipital region. A CT angiogram has findings of moderate atherosclerotic calcifications, but the extracranial and intracranial vessels are widely patent. A 24-hour monitor observed 1,784 isolated premature atrial complexes (PACs) but no atrial fibrillation (AF). Cardiac echocardiography has findings of normal biventricular size and function with left atrial (LA) enlargement (volume index 38 mL/m2 [normal 16-34 mL/m2]).
Which one of the following factors does not suggest AF as the cause of her stroke?
Show Answer
