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Women At Higher Risk Of Having A Stroke With Afib

You don’t want this…

When it comes to the risk of stroke in atrial fibrillation, it pays to be a boy. Sorry, ladies.

An important question came up on my recent post on AF and stroke.

Why does being female give you an automatic point on CHADS2-VASc?  I keep seeing it, but I don’t see why that is.

It doesn’t seem intuitive that female AF patients should have more strokes. Why? AF should equal AF.

But it does matter. When it comes to AF and stroke, women are very different.

Here are three references that support the fact that female gender increases the risk of stroke in AF.

–First: Read more »

*This blog post was originally published at Dr John M*

The Case Of The Accidental Chemo Burn

One of the great things of being in a group practice is meeting and taking care of patients who may not necessarily be on your own personal patient panel. Walking into the room, I hear the patient say, “Doc, you gotta help me.” I see a red right forearm and on the “complaint” section, the nurse wrote “burn.”

So, I ask, “Well how did you burn your arm?” “Well, doc, I got cancer.” Hmm, that’s interesting. I didn’t make the connection until the next sentence. “It was my last treatment with chemotherapy about 2 weeks ago and for some reason, the needle slipped and the stuff went all over my arm. The cancer doc prescribed these pills, but they don’t seem to be helping. I asked the pharmacist about some salves and this is what they said.” He showed me a handful of creams and ointments purchased at the pharmacy.

Since I didn’t know this patient at all, I was leafing through a very thick paper chart to try to catch up. “Yeah, I’ve been coming to see Doc [name] for a long time now. I’m glad you were able to see me today since his schedule was full.” This very pleasant patient then told me about how they diagnosed his cancer – a tear came to his eye – it’s like he was re-living that moment again. Read more »

*This blog post was originally published at Doctor Anonymous*

Gallbladder Surgery, Medical Errors, And John Murtha

While the news reports that Representative John Murtha of Pennsylvania died after complications from gallbladder surgery, the question no one is asking is whether his death was a preventable one or simply an unfortunate outcome. According to the Washington Post, Murtha had elective laproscopic gallbladder surgery performed at the Bethesda Naval Hospital and fell ill shortly afterwards from an infection related to his surgery.

He was hospitalized to Virginia Hospital Center in Arlington, Virginia, to treat the post-operative infection. His care was being monitored in the intensive care unit (ICU), a sign which suggests that not only was the infection becoming widespread but also that vital organ systems were shutting down. Read more »

*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*

Stroke During Coronary Bypass Surgery – an Article Review

My mother died last Tuesday.  She had her coronary bypass surgery just one week before that day.  It was during her CABG that she had her strokes.  Yes, strokes, plural.  She was one of those 1.5% who suffer macroemboli cerebral strokes during coronary bypass surgery.

I went looking for information on it earlier this week.  I went through my training without ever seeing this complication.  Like everyone, I never thought my family would be the one.  I think it is better to go to surgery, NOT thinking you will be the “statistic” as far as complications go.  Anyone having surgery, SHOULD go into it feeling hopeful and thinking everything will go perfectly.

The article referenced below is a good review of this complication – stroke during coronary bypass surgery. The study is a retrospective review of 6682 consecutive coronary bypass patients who only had the CABG procedure and not other simultaneous procedures, such as carotid endarterectomy.

They list the possible sources of the emboli as the ascending aorta, carotid arteries, intracerebral arteries, or intracardiac cavities.  They state that they believe the most likely source is the ascending aorta, for the following reasons:

First, the ascending aorta is the site of surgical manipulations during CABG, whereas mechanical contact is not made with the other potential sources of emboli.  Embolization of atherosclerotic debris is most likely to occur during aortic  cannulation/decannulation, cross-clamp application/removal, and construction of proximal anastomoses. However, embolization of atherosclerotic debris may also occur when the aorta is not being surgically manipulated, due to the ‘sandblast’ effect of CPB.

Second, the majority of our independent predictors of stroke – elderly age, left ventricular dysfunction, previous stroke/TIA, diabetes, and peripheral vascular disease – are strongly associated with atherosclerosis of the ascending aorta.

Third, our chart review suggested that the most common probable cause of stroke was atherosclerotic emboli from the ascending aorta. Palpable lesions in the ascending aorta were noted in a large proportion of stroke patients.

The fourth reason we believe the ascending aorta is the likely source of macroemboli is because of ancillary autopsy data. …….

Note the second reason given above – the independent predictors of stroke.  My mother was over 74 yr so fell into the elderly age risk factor group.  She was also a type 2 diabetic.  She was noted to have a small abdominal aneurysm and some renal artery stenosis on the angiogram (an accidental pickup).  So she had three of the four independent risk factors.


Stroke during coronary bypass surgery: principal role of cerebral macroemboliEur J Cardiothorac Surg 2001;19:627-632; Michael A. Borger, Joan Ivanov, Richard D. Weisel, Vivek Rao, Charles M. Peniston

*This blog post was originally published at Suture for a Living*

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