Haniff Shaniza, Shive Gowda Ashwin, Al-Khafaji Nawfal, Gorantla Asher
Internal Medicine, University at Buffalo, New York, USA.
Neurology, Royal Stoke University Hospital, Stoke-on-Trent, GBR.
Cureus. 2024 Feb 9;16(2):e53913. doi: 10.7759/cureus.53913. eCollection 2024 Feb.
Atrial fibrillation (AF), a common cardiac arrhythmia, is often accompanied by aortic plaques that are associated with an increased risk of embolic events, including stroke. Evidence-based management in this population is lacking. We present a case of a 77-year-old female with new-onset AF who was found to have a high-risk aortic plaque at the level of the ascending aorta and ostium of the right coronary artery. Definitive treatment for AF, cardioversion, high-risk aortic plaque, and cardiothoracic surgery, could not be performed due to the elevated risk of ischemic stroke and embolic complications. Based on existing literature, the cardiologist and cardiothoracic surgeon collaboratively decided to treat both conditions with anticoagulation, statin, and periodic imaging surveillance of high-risk aortic plaque. The patient was successfully managed without any thromboembolic complications despite an elevated risk. This case report provides a comprehensive literature review of managing AF with high-risk aortic plaques. It delves into the integration of anticoagulation and antiplatelet agents in the dual challenge of stroke prevention in AF and mitigating embolic risks associated with aortic plaques. To date, there has been no consensus on managing AF and high-risk aortic plaques; thus, we aim to fill this gap.
心房颤动（AF）是一种常见的心律失常，常伴有主动脉斑块，而这些斑块与包括中风在内的栓塞事件风险增加有关。目前缺乏针对该人群的循证管理方法。我们报告一例77岁新发AF女性病例，该患者在升主动脉和右冠状动脉开口处发现有高危主动脉斑块。由于缺血性中风和栓塞并发症风险升高，无法对AF、心脏复律、高危主动脉斑块以及心胸外科手术进行确定性治疗。基于现有文献，心脏病专家和心胸外科医生共同决定采用抗凝、他汀类药物治疗这两种病症，并对高危主动脉斑块进行定期影像学监测。尽管风险升高，但患者成功得到管理且未出现任何血栓栓塞并发症。本病例报告提供了关于合并高危主动脉斑块的AF管理的全面文献综述。它深入探讨了在AF预防中风和减轻与主动脉斑块相关的栓塞风险这一双重挑战中抗凝剂和抗血小板药物的联合应用。迄今为止，对于AF和高危主动脉斑块的管理尚无共识；因此，我们旨在填补这一空白。
