Epi of paradoxical embolism

Q: Patients with paradoxical embolism are usually younger? (select one)

A) True

B) False

Answer: A

Paradoxical embolism implies a thrombus in the venous circulation entering the arterial side. This mainly occurs via heart defects, mostly patent foramen ovale (PFO). Younger patients (average age 39 years) are more prone to paradoxical embolism than other patients who develop other forms of arterial thromboembolization (average age 68 years). 

There is a misconception that patients with paradoxical embolism only present with stroke, popularly known as cryptogenic stroke. There is a substantial number of patients who may develop acute extremity ischemia. 

Younger age should prompt a clinician to look for cardiac defects.

#cardiovascular

#hematology

References:

1. Miller S, Causey MW, Schachter D, et al. A case of limb ischemia secondary to paradoxical embolism. Vasc Endovascular Surg 2010; 44:604.

2. Dao CN, Tobis JM. PFO and paradoxical embolism producing events other than stroke. Catheter Cardiovasc Interv 2011; 77:903.

3.Hugl B, Klein-Weigel P, Posch L, et al. Peripheral ischemia caused by paradoxical embolization: an underestimated problem? Mt Sinai J Med 2005; 72:200

4. Herity NA, Dalzell GW. Venous thrombosis causing arterial embolization to the same limb through a patent foramen ovale. Clin Cardiol 1997; 20:893.