Patent foramen ovale, deep venous thrombosis and stroke; a paradoxical embolism in an 80-year-old male

Background: A patent foramen ovale (PFO) is a congenital cardiac malformation describing a shunt in between the atrial walls. The overall incidence of a PFO is around 27.3% with a progressive decrease to 25.4% in the 4th and 8th decades. Once it has been established that a patient with an ischemic stroke/transient ischemic attack (TIA) has a PFO and other sources of the stroke have been ruled out, it is imperative to consider deep vein thrombosis (DVT) as the source of a paradoxical embolus. Case Presentation: 80-year-old gentleman with a history of right internal carotid occlusion of 80-90% status post right internal carotid endarterectomy. Presented to the emergency department (ED) for sudden left-sided weakness, left facial droop, slurred speech, and dizziness. Upon initial evaluation he was asymptomatic; NIH stroke score 1. Magnetic resonance imaging of the brain showed important watershed infarcts. Cerebral angiogram found 50% concentric stenosis of the right middle cerebral artery (MCA) with minimal lineal filling defect in the stenotic segment. The filling defect cleared after injection of intra-arterial integrillin. Post procedure, patient was started on heparin drip. Cardiology was consulted for suspected paroxysmal atrial fibrillation and a transesophageal echocardiogram (TEE). Two days after the post cerebral angiogram, the patient began to complain of severe right leg pain. He was noted to be tachycardic and hypoxemic. The venous doppler of the leg revealed a DVT and subsequent CT chest angiography revealed bilateral pulmonary embolism (PE). TEE results showed a positive agitative saline test with defect in the intra-atrial wall. The patient was on heparin drip and transitioned after 7 days to oral anticoagulation. Loop recorder was installed with possible PFO correction by cardiology in the outpatient. Patients\u27 symptoms improved and he was discharged to inpatient rehab. Conclusion: Although rare a paradoxical embolus should be considered in patients presenting with a stroke/TIA, PFO, and an unidentified source of embolus. Although this patient did have 50% occlusion of the R MCA, we cannot fully exclude a PFO-related stroke. The discovery of a DVT, and bilateral PEs supports the high suspicion for PFO-related stroke in the form of paradoxical embolus

UTRGV Student Run Clinic: The Past, The Present, and The Future

Purpose: The UTRGV SOM Student Run Clinic (SRC) is a student- led organization that provides free primary care and promotes health equity in the Rio Grande Valley. Through the SRC, barriers of access to healthcare and health promotion are targeted, especially by emphasizing health literacy and patient advocacy. The SRC benefits not only our patients but medical students who work in the clinic, learning about the unique needs and culture of the underserved community while gaining clinical experience. Description: The SRC brings teams of volunteer medical students and physicians to Peñitas, TX to provide free primary healthcare to vulnerable populations, including uninsured, undocumented, and low-income people. Since its start, SRC has grown through success and obstacles, such as structuring all our volunteer teams to include at least one Spanish speaker to provide care in the patients preferred language and establishing culturally competent relationships with the Peñitas community. Partners: The SRC relies on our partnerships: the Peñitas community, medical student and physician volunteers, and the Proyecto Desarrollo Humano (PDH). PDH is a non-profit organization in Peñitas that allows us use of their clinic space as well as gives our patients continuity of care between our operations in their own clinic. The community of Peñitas is a source of our patients but also of clinic staff and promotoras that connect the patients to external resources. Medical student volunteers work in teams to conduct patient interviews and present to physician volunteers, who teach students and see patients. The SRC board of medical students manages and executes the clinic operations. Looking Ahead: The SRC is an important part of decreasing disparities in the colonia we serve. We will perform a literature review of SRC publications, review and realign our board member roles, and perform an analysis of our Strengths, Weaknesses, Opportunities and Threats (SWOT) with stakeholders to strategize for our future. Lastly, we will develop and present our five-year strategic plan as a result of this exercis

Influence of Age, Race, and Ethnicity on Pre-hospital Stroke Time Intervals in the Rio Grande Valley.

Currently, stroke represents one of the leading causes of death in the USA. Despite recent advances in acute stroke management such as thrombolytic administration and/or endovascular intervention, many patients remain ineligible for these treatments due to delay in treatment. There has been a great emphasis by healthcare professionals on improving “door to needle” time with very encouraging results. Unfortunately, there still exists a gap in these delays, and that is the onset to hospital presentation interval. This study aims at evaluating the time interval from the onset of the symptoms to when the patient presents to the healthcare facility. The identification of factors related to early or delayed hospital arrival may uncover potential targets for intervention in the reduction of these time intervals. A potential intervention includes identifying the most vulnerable age groups or ethnicities and provide age, cultural, or language specific public awareness programs. We are in the process of performing a retrospective chart review using UT health Rio Grande Valley and Doctor’s Hospital at Renaissance stroke data to identify the pre-hospital times for patients who were diagnosed with a cerebrovascular accident. This includes ischemic/hemorrhagic strokes, and transient ischemic attacks (TIA). Once the times are obtained, the data will be stratified into age, race, and ethnicity. The aim is to identify patterns or factors related to early or delayed symptom recognition and presentation to the healthcare facilities. The section presented in this abstract is part of a larger study including socioeconomic determinants such as the use or lack of insurance, place of residence, and the use of emergency medical services