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Cryptogenic TIA — RCPSC IM MCQ

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HardCardiologyCryptogenic TIARCPSC IM

A 78-year-old woman with hypertension and prior TIA reports intermittent palpitations, but office ECG shows sinus rhythm. Brain MRI shows a small embolic-appearing infarct, carotid imaging shows no significant stenosis, transthoracic echocardiography is unrevealing, hemoglobin is normal and creatinine clearance is 54 mL/min. What is the most appropriate investigation?

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Correct answer: D — Prolonged ambulatory rhythm monitoring for paroxysmal atrial fibrillation

Cryptogenic TIA or embolic-appearing stroke with palpitations warrants prolonged rhythm monitoring to detect paroxysmal atrial fibrillation, which would change secondary prevention to anticoagulation.

Reference: Canadian Stroke Best Practices; CCS/CHRS atrial fibrillation guideline