Cleveland Clinic journal of medicine
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The Assessment of Cardioversion Using Transesophageal Echocardiography (ACUTE) trial compared cardioversion following transesophageal echocardiography (TEE) against conventional management of atrial fibrillation (ie, cardioversion following 3 weeks of anticoagulation) in patients scheduled to undergo electrical cardioversion.
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Although intravenous tissue plasminogen activator (i.v. tPA) has been approved for treating acute ischemic stroke, it must be given within 3 hours of stroke onset and only after ruling out hemorrhagic stroke by computed tomography. Several medical centers are turning to angiography to guide intra-arterial infusion of thrombolytic agents and mechanical endovascular interventions.
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No single imaging study or blood test is 100% sensitive and specific for pulmonary embolism. A combination of pretest clinical probability assessment, noninvasive pulmonary imaging (V/Q scanning or spiral CT), and D-dimer testing seems prudent before pursuing pulmonary angiography.