A 68-year-old man in atrial fibrillation presents with a cold, pulseless left leg of 4 hours onset. Which is the single most common source of peripheral arterial emboli?

• A Mural thrombus overlying a left ventricular infarct
• B Venous thrombus crossing a patent foramen ovale
• C Atheromatous debris from an ulcerated aortic plaque
• D Thrombus in the left atrium or left atrial appendage in atrial fibrillation ✓

Explanation

About 80 percent of peripheral arterial emboli arise from the heart, and atrial fibrillation with thrombus in the left atrium or its appendage is the commonest cardiac source. Left ventricular mural thrombus after myocardial infarction is the next most frequent source and is the tempting distractor, but it accounts for a smaller share. Atheroemboli are typically small vessel and digital, and paradoxical embolism through a patent foramen ovale is rare.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.