Acute Radial Artery Occlusion in a Diabetic Woman with Paroxysmal Atrial Fibrillation That Became Chronic and Caused Cerebral Infarction

Abstract

A 75-year-old diabetic woman with arterial hypertension admitted for 1.5 hours of pain and coldness in her right forearm was found in arteriography to have a completely occluded radial artery, which was treated with direct injection of a thrombolytic agent into the brachial artery.Signs and symptoms of acute radial artery obstruction disappeared immediately after injection.After 15 days, repeated arteriography failed to show atherosclerotic changes in her right radial artery.Routine electrocardiographic (ECG) monitoring showed no abnormalities except for a pathological Q wave in leads V1-3.Myocardial perfusion scintigraphy showed a septal defect and UCG showed an enlarged left atrium but no abnormal wall motion.Frequent Holter monitoring showed asymptomatic paroxysmal atrial fibrillation (PAf).Increased risk of nonvalvular atrial fibrillation is reported to be associated with a history of coronary disease, hypertension, diabetes and an enlarged left atrium.We concluded that her arterial occlusion was due to PAf.Some 18 months after this episode, her PAf developed into CAf, which caused a cerebral embolism even though she was treated with warfarin.
Because PAf has been reported to carry a risk of thromboembolism, which approaches that of established chronic atrial fibrillation in those with heart disease, we suggest that diabetic patients with many risk factors be given Holter monitoring even if their ECGs are normal.