Cold Hand

Cardiovascular System

{"ops":[{"insert":"Diagnosis and reasoning"},{"insert":"\n","attributes":{"header":1}},{"insert":"This middle aged lady has presented with sudden pain and numbness of her left hand, while examination reveals the affected extremity to be cold and pulseless; this is acute upper limb ischemia (AULI) until proven otherwise.\n\nThe explosive onset of symptoms favors an embolism, with the history of recurrent palpitations suspicious of a cardiac origin.\n\nCT arteriography is the gold standard diagnostic study in suspected AULI; here, it reveals an obstructive lesion at the bifurcation of the brachial artery. Note that this is suggestive of an embolism, as emboli often lodge at the branching points of an artery.\n\nThe otherwise pristine vasculature also favors an embolism, as thrombosis mainly occurs in diseased vessels.\n\nAn ECG and Echocardiogram should also be performed, both for preoperative preparation, and to look for a cardiac origin of emboli; these reveal (previously undiagnosed) atrial fibrillation, the most common individual etiology implicated in AULI.\n\nAs there are no clinical fin"}]}

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