Of the following patients, who has the maximum need to be anticoagulated?

1. Patient who occasionally gets Atrial fibrillation and has a history of rheumatic mitral stenosis.

2. Patient who occasionally gets Atrial fibrillation and has a brother who has had a TIA. Patient's Echo shows no spontaneous echo contrast. Ejection fraction is 35%.

3. Patient who has Atrial fibrillation and has spontaneous echo contrast. Ejection fraction is 55%.

4. Patient who has Atrial fibrillation and is otherwise healthy. Echo has no Spontaneous Echo Contrast and EF is 55%.

Answer is 1. Patients with rheumatic valvular damage and Atrial fibrillation have the highest risk of stroke. Lone atrial fibrillation, as in 4. is the lowest risk patient.

CARDIOLOGY

Select the appropriate therapy to prevent an embolic stroke in an elderly patient with heart disease and nonvalvular (without mitral stenosis) atrial fibrillation.

Explanation:

The risk of stroke in a patient with atrial fibrillation is approximately 5 times that of general population. Those with valvular type AF have a risk of 15 times that of normal (normal being about 1%/yr)

Coumadin(Warfarin) to keep INR between 2 and 3 unless contraindicated because of repeated falls or dementia and non compliance where the risk of bleeding may be high.  Coumadin reduces the relative risk by ~70% and ASA reduces it by ~35%.