Clinical presentation of paradoxical obstruction: what should I know?

When posting content from Clinical decision book Today we will talk about a condition in heart disease, which is paradoxical obstruction. It constitutes an important cause of ischemic events in young people, especially related to the brain, and is characterized by the clinical triad:

The condition begins with the formation of an embolus in the venous circulation (especially in the lower extremities), which passes into the arterial circulation through an intracardiac connection (the most common patent foramen ovale), generating an arterial ischemic state in the vessels of the brain (stroke), coronary artery ( acute myocardial infarction), kidney or extremities. The piston can be of any nature (e.g. stroke, air or fat).

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Clinical presentation of paradoxical obstruction

The manifestations are non-specific, making diagnosis difficult. Patients may have neurological changes or other symptoms suggestive of arterial occlusion (eg, peripheral, coronary, renal). It can occur in young patients without risk factors for cardiovascular disease. A case consistent with obstruction in a young patient without risk factors should prompt investigations into paradoxical obstruction.

Symptoms vary depending on the location of the blockage:

• Stroke or transient ischemic attack: hemiplegia, dysplasia, visual changes, seizures.
• Acute coronary syndrome: chest pain, shortness of breath, and profuse sweating.
• Peripheral arterial occlusion: pain, paresthesia, cyanosis.

Danger signs:

• Occurrence of complications (such as: neurological sequelae, amaurosis, gangrene in the extremities, kidney failure).

Risk factors for venous thrombosis:

• Thrombophilia.
• Paralysis.
• pregnancy;
• Estrogen use.
• Previous history of venous thrombosis.
• shock;
• Tumors.
• Surgical operations (mainly orthopedic, abdominal and urogenital surgery).

Reasons for communication within the heart:

• patent foramen ovale;
• Atrial septal defect.
• Pulmonary arteriovenous malformation.
• Ventricular septal defect.
• Patent ductus arteriosus.

Physical examination for paradoxical obstruction

Patients with deep vein thrombosis experience edema, pain, and redness in the affected limb. Peripheral arterial occlusion presents with cold, bluish, or pale extremities.

In the case of stroke or transient ischemic attack, focal neurologic deficits, aphasia, and cranial nerve palsies may be evident.

In acute coronary syndrome, the condition is similar to that of acute myocardial infarction, with sweating, tachycardia, and pallor.

To learn more about the condition and its treatment, visit Whitebook > Home > Internal Medicine > Cardiology > Paradoxical Embolism. Or click here!