A 60-year-old man is admitted to the coronary care unit with a large anterior wall myocardial infarction. On his second hospital day he begins to complain of the sudden onset of numbness in his right foot and an inability to move his right foot. On physical examination, the right femoral, popliteal, and pedal pulses are no longer palpable. Vascular consultation is obtained. Diagnosis of acute arterial embolus is made. Which of the following statements concerning this condition is true?
The heart is the most common source of arterial emboli and accounts for 90% of cases. Within the heart, sources include diseased valves, endocarditis, the left atrium in patients with unstable atrial arrhythmias, and mural thrombus on the wall of the left ventricle in patients with a myocardial infarction. The diagnosis in this patient is clear, and therefore neither noninvasive testing nor arteriography is indicated. Arteriography in fact may also prove to be too stressful for a patient undergoing an acute myocardial infarction. Embolectomy of the femoral artery can be performed under local anesthesia with minimal risk to the patient. Emboli typically lodge in one femoral artery; contralateral exploration is not indicated in the absence of signs or symptoms. One should always prepare the contralateral groin in case flow is not restored via simple thrombectomy and femoral-femoral bypass is needed to provide inflow to the affected limb.
Appropriate management would be embolectomy of the right femoral artery under general anesthesia
Noninvasive hemodynamic testing is required
Prophylactic exploration of the contralateral femoral artery should be done despite the presence of a normal pulse
The source of the embolus is most likely the left ventricle
Arterial Disorders