Non ischemic Cardiomyopathy with stroke

A 56 year- old man with no ischemic cardiomyopathy is seen in the clinic following a recent hospitalization for a small left frontal stroke.His MRI at that showed a small acute stroke in the right hemispheric white matter.Echocardiography during the hospital stay showed an ejection fraction of 25% with put evidence of intracardiac thrombus ,and ongoing cardiac monitoring has yet to reveal signs of atrial fibrillation. Which of the following is the best next step in management ?. A Antiplatelet or anticoagulant medication depending on hemorrhagic risk. B Long term dual antiplatelet therapy with aspirin & clopidogrel. C Ref to left atrial appendage occlusion. D Referral to pacemaker placement. E Wardarin with goal international normalized ratio of 1.5 to 2.0.


CONCLUSION. Thanks for all answers. The correct answer is A Antiplatelet or anticoagulant medication. This patient is presenting with a recent stroke, most likely from a cardiometabolic mechanism.His decreased cardiac ejection fraction may be the sourse of his stroke,particularly since another sourse ( such as Atrial fibrillation ) has yet to be found.In this setting ,no evidence supports antiplatelet or anticoagulant therapy for secondary stroke prevention ; either can be considered ,depending in part on the perceived risk of bleeding complications with anticoagulation.

B dual antiplatelets. In case of warfain the target INR should be 2.5- 3

E but accordingly after sr creat report and pt inr report

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