Acute Limb Ischemia

Question 1

55M + hyperthyroidism + pulses absent in left lower extremity; Dx?

Answer 1

arterial embolic occlusion; acute limb ischemia in this case is caused by left atrial mural thrombus, secondary to
hyperthyroidism-induced atrial fibrillation, launching off to the femoral artery

AF can also lead to clot launching off to brain (stroke) or SMA/IMA (acute mesenteric ischemia).

Question 2

Key differentiation for arterial occlusion vs DVT

Answer 2

absence of pulses indicates arterial occlusion; in contrast, in DVT, pulses are normal, since the arteries are fine

Question 3

Severe pain in a leg + absent pulses in patient with irregularly irregular rhythm

Answer 3

acute limb ischemia

Question 4

Tx acute limb ischemia

Answer 4

embolectomy

Question 5

“Emboli” refers to Hx of AF leading to stroke, TIA, acute, mesenteric ischemia, or acute limb ischemia – i.e., any Hx of embolic event. 2CK IM form gives short vignette of 67F with chronic AF + Hx of acute limb ischemia + no other info
relating to CHADS. Tx?

Answer 5

warfarin to prevent recurrence; aspirin is wrong.

Question 6

Acute limb ischemia after MI suggests

Answer 6

Embolization of LV thrombus

Question 7

NBS following Embolization of LV thrombus resulting in Acute limb ischemia after MI

Answer 7

Echo to look for LV aneurysm or residual LV thrombus