Myocardial Infarction with Left Ventricular Aneurysm (see Left Ventricular Aneurysm, [[Left Ventricular Aneurysm]]): usually antero-apical with associated decreased systolic function
Left Ventricular Dysfunction/Cardiomyopathy with Decreased Cardiac Output (see Congestive Heart Failure, [[Congestive Heart Failure]])
Mechanical Prosthetic Mitral/Aortic Valve: usually in the setting of inadequate anticoagulation
Mitral Annular Calcification
Papillary Fibroelastoma: cardiac tumor usually found on the mitral/aortic valves
Arterial Source: account for 20% of arterial emboli
Aortic Atherosclerotic Plaque/Cholesterol Emboli Syndrome (see Cholesterol Emboli Syndrome, [[Cholesterol Emboli Syndrome]]): risk of embolization is increased with increased plaque thickness, plaque ulceration or mobility, and cardiovascular procedures (cardiac catheterization/intra-aortic balloon pump/cardiac surgery may dislodge the plaque)
Paradoxical Embolism: account for 2-4% of arterial emboli
Epidemiology
Patients with paradoxical embolization are typically younger (mean age: 39) than patients with other types of arterial thromboembolization (mean age: 68)
Patients with paradoxical embolization typically have little evidence of cardiac or peripheral arterial disease
Mechanism: venous thrombosis that traverses a right-to-left intracardiac shunt (patent foramen ovale, atrial septal defect, atrial septal aneurysm)
Venous Sources
Upper/Lower Extremity Deep Venous Thrombosis (DVT)
Destination of Arterial Embolism
General Comments
Lower extremities are affected more commonly than upper extremities
Emboli commonly lodge in sites of arterial narrowing: at atherosclerotic plaques or bifurcation points (common femoral bifurcation, common iliac bifurcation, popliteal artery bifurcation)
Femoral Artery: 28% of cases
Upper Extremity Artery: 20% of cases
Aortoiliac: 18% of cases
Popliteal Artery: 17% of cases
Visceral Artery: 9% of cases
Other Artery: 9% of cases
Arterial Thrombosis
General Comments
Arterial thrombosis usually occurs at the site of an atherosclerotic plaque, in arterial aneurysms, at the site or within a prior revascularization (stents, grafts), or in a vein bypass (usually at a site of venous abnormality)
Atherosclerotic Plaque: the degree of limb ischemia in a patient with pre-existing atherosclerotic plaques in the affected distribution may be less severe, due to the prior development of collateral circulation