A 72-Year-Old Man Comes to the Emergency Department Due to Left-Sided

question 148

Multiple Choice

A 72-year-old man comes to the emergency department due to left-sided weakness and speech difficulty upon awakening this morning.  Medical history includes hypertension and persistent atrial fibrillation.  His anticoagulant medication was stopped 6 months ago after an episode of gastrointestinal bleeding.  Blood pressure is 160/90 mm Hg and pulse is 88/min and irregular.  Examination shows mild dysarthria, left lower facial weakness, and left hemiparesis.  CT scan of the head shows no evidence of intracranial bleeding.  Transthoracic echocardiogram shows left atrial enlargement, normal left ventricular systolic function, and mild mitral regurgitation.  The patient's symptoms are determined to be caused by a thromboembolic event.  Which of the following is the most likely source of the thrombus?

• A)Crista terminalis
• B)Left atrial appendage
• C)Left ventricular apex
• D)Mitral valve
• E)Pulmonary veins
• F)Right atrial appendage
• G)Sinus of Valsalva

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