Joe Perez, D.O.• Cardiologist at Cardiovascular

Group/Gwinnett Medical Group

• Board Certified in Internal medicine.

• Cardiology fellowship at Nova Southeastern University/Palmetto General Hospital in Hialeah

• Special interests include: Adult echocardiography and transesophageal echocardiography, as well as nuclear cardiology.

Medical School:Nova Southeastern

University

Residency:Mount Sinai Medical

Center

Fellowship:Nova Southeastern

University

C RY P T O GE N I C S T R O K EJOSEPH PEREZ DO

S T R OK E D E N I N I T I O N

T OA S T C L A S S I F I C AT I ON

AFIB SUMMIT

• Hemorrhagic

• Ischemic

ISCHEMIC

• Small vessel

• Large vessel athero embolism

• Embolic

• Systemic hypo perfusion

• Cryptogenic stroke

• Definition

• Importance

• Implication

• Role of undiagnosed atrial fibrillation

• Impact

• Challenges of detection

• Empiric treatment not feasible

Challenges in detection

• Intermittent nature

• Duration of monitor

• Inconvenience

• Invasive

• invasive nature of more prolonged monitoring vs unknown yield

• fairly rare to detect with conventional monitoring

• Data from pacemakers gave us some idea

• Conventional strategy

• Embrace

• Crystal AF

QUESTIONS

Which of these patients meets the criteria for cryptogenic stroke according to the Toast classification?

a)  Hypertensive patient with a sub cortical stroke b)  patient with intra ventricular bleed and midline shift c)  patient with multi territory infarct found to have left atrial appendage clot on trans esophageal echocardiogram d)  patient with multi territory stroke, atrial fibrillation and evidence of significant ipsilateral common carotid obstruction e)  none of these

How many patients are diagnosed with cryptogenic stroke are diagnosed yearly in the US?

a) 50,000 b) 150,000 c) 250,000 d) 500,000

Of these, what percentage are preventable with adequate thromboembolic prophylaxis? a) 25% b) 40% c) 50% d) 70% e) 100%

Implanting a Reveal Linq will preclude MRI for How long?

a) The device is not MRI compatibleb) you must wait 2 weeksc) you must wait one monthd) there is no wait time, MRI may be performed at any time post implantation

what percentage of eligible patients were placed on anticoagulant therapy post afib detection?

a) 50% b) 80% c) 90% d) 100%

QUESTIONS?