6/20/2010

Cath: Screening before PFO closure

Name, Age, Gender
Handedness
Race
PMH: CAD, DM, HT, Hyperchol, Afib, Carotid Dz, PE, DVT, First trimester miscarriage (How many), Migraine (with or without aura)
Family Hx: PE, DVT, Miscarriage
Smoker: Current, Former
ETOH: (amt, current, Former)
Meds at the time of episode: (Antiplatelet, Warfarin, Statin, OCP, Other)
Initial complaint: (Description, Date & Time)
Nature of episode: TIA, Stroke, Peripheral embolism, Other, Retinal ischemia
Valsalva in history: (lifting, coughing, straining, laughing, sex within 30 min of onset). If yes, explain
Prolonged immobility: (hospitalization, travel, etc. within 1 week of episode)
Concurrent illness:
Previous spell suggestive of TIA/Stroke/Peripheral emb - Dates if yes)
Evidence of multiple lesions on exam
Cardiac murmur
Crochetage in EKG

Investigations:
Protein C & S
AT-III
Factor V Leiden (APC res.)
Lupus anticoagulant
Anticardiolipin AB
Antiphosphotidylserine Ab
Prothrombin gene mutation
Homocysteine
Cholestrol panel (TC, HDL, LDL, TG)
TOAST criteria:
Large vessel (Probable, Possible)
Cardioembolic (Probable - Lesion _____, Possible)

Some references:
JACC 2005;46:1768-76. State of the art paper. Patent Foramen Ovale: Current pathology, pathophysiology, and clinical status.

Stroke 2004;35:803-4. Patent foramen ovale and recurrent stroke: Closure is the best option: Yes.
Stroke 2004;35:804-5. Patent foramen ovale and recurrent stroke: Closure is the best option: No.
Stroke 2004;35:806. Patent foramen ovale and stroke Closure by further randomized trial is required.

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