{"version":"1.0.0","segments":[{"startTime":0.0,"endTime":2.686,"body":"♪ (music) ♪"},{"startTime":3.266,"endTime":5.563,"body":"(Cathy) Hi, welcome"},{"startTime":3.266,"endTime":5.563,"body":"to Harrison's Podclass,"},{"startTime":5.563,"endTime":8.303,"body":"where we discuss important concepts"},{"startTime":5.563,"endTime":8.303,"body":"in internal medicine."},{"startTime":8.303,"endTime":9.697,"body":"I'm Cathy Handy."},{"startTime":9.697,"endTime":11.147,"body":"(Charlie) And I'm Charlie Wiener,"},{"startTime":11.147,"endTime":14.234,"body":"and we're coming to you from"},{"startTime":11.147,"endTime":14.234,"body":"the Johns Hopkins School of Medicine."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":17.617,"endTime":20.897,"body":"A 27-year-old"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":17.617,"endTime":20.897,"body":"with Post-Partum Hemiparesis."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":20.897,"endTime":22.3,"body":"(Charlie) Here's the question."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":22.3,"endTime":26.683,"body":"A 27-year-old previously healthy woman"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":22.3,"endTime":26.683,"body":"is brought to the emergency department"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":26.683,"endTime":29.599,"body":"three days after the delivery"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":26.683,"endTime":29.599,"body":"of a healthy, full term infant,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":29.599,"endTime":32.415,"body":"having presented"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":29.599,"endTime":32.415,"body":"with new, right hemiparesis"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":32.415,"endTime":34.639,"body":"and a blue left hand."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":34.639,"endTime":38.682,"body":"Physical examination is also notable"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":34.639,"endTime":38.682,"body":"for diffuse livedo reticularis."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":38.682,"endTime":40.022,"body":"(Cathy) Let me stop you right there."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":40.022,"endTime":42.598,"body":"So, one, this woman is obviously"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":40.022,"endTime":42.598,"body":"having a stroke."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":42.598,"endTime":45.448,"body":"The right-sided hemiparesis"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":42.598,"endTime":45.448,"body":"and a blue left hand"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":45.448,"endTime":47.481,"body":"really points to arterial thrombosis,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":47.481,"endTime":50.798,"body":"and in this case it would be involving"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":47.481,"endTime":50.798,"body":"the arteries of the arms"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":50.798,"endTime":52.448,"body":"and the cerebral vasculature."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":52.448,"endTime":55.25,"body":"Livedo reticularis, which is also"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":52.448,"endTime":55.25,"body":"the mottling"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":55.25,"endTime":57.498,"body":"or purplish discoloration of the skin,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":57.498,"endTime":60.816,"body":"is also caused by obstruction"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":57.498,"endTime":60.816,"body":"of capillaries by thrombi."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":60.816,"endTime":63.83,"body":"(Charlie) Why make that distinction"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":60.816,"endTime":63.83,"body":"that this is an arterial thrombosis?"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":63.83,"endTime":65.397,"body":"(Cathy) Well, arterial thrombosis"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":65.397,"endTime":67.76,"body":"is initiated differently"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":65.397,"endTime":67.76,"body":"than venous thrombosis,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":67.76,"endTime":70.075,"body":"although they do share"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":67.76,"endTime":70.075,"body":"some common risk factors"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":70.075,"endTime":72.961,"body":"like older age, obesity"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":70.075,"endTime":72.961,"body":"and cigarette smoking."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":72.961,"endTime":76.88,"body":"Arterial thrombosis is primarily"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":72.961,"endTime":76.88,"body":"initiated by activation of the platelets."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":76.88,"endTime":79.711,"body":"In thinking about the most common cause"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":76.88,"endTime":79.711,"body":"of this in the United States,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":79.711,"endTime":82.561,"body":"it really would be heart attacks"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":79.711,"endTime":82.561,"body":"or coronary artery disease."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":82.561,"endTime":87.094,"body":"Venous thromboembolism, on the other hand,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":82.561,"endTime":87.094,"body":"is primarily initiated by vascular injury,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":87.094,"endTime":89.497,"body":"which exposes tissue factor"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":87.094,"endTime":89.497,"body":"to blood components,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":89.497,"endTime":93.01,"body":"which activate the coagulation cascade"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":89.497,"endTime":93.01,"body":"and lead to clot."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":93.01,"endTime":95.126,"body":"There aren't that many causes"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":93.01,"endTime":95.126,"body":"or arterial thrombosis,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":95.126,"endTime":97.196,"body":"and they aren't the same"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":95.126,"endTime":97.196,"body":"as what causes DVT"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":97.196,"endTime":99.476,"body":"so it's important"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":97.196,"endTime":99.476,"body":"to make that distinction."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":99.476,"endTime":102.214,"body":"Let's get back to the question though."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":99.476,"endTime":102.214,"body":"Tell me more about the case."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":102.214,"endTime":105.292,"body":"(Charlie) Okay, we have a woman here,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":102.214,"endTime":105.292,"body":"three days post-partum"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":105.292,"endTime":108.559,"body":"who presents with a stroke"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":105.292,"endTime":108.559,"body":"and a blue left hand."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":108.559,"endTime":111.842,"body":"In the emergency department"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":108.559,"endTime":111.842,"body":"she is afebrile,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":111.842,"endTime":114.228,"body":"she has a blood pressure of 135 over 80,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":114.228,"endTime":116.558,"body":"a regular heart rate of 85 per minute,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":116.558,"endTime":120.792,"body":"and a respiratory rate of 18 per minute"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":116.558,"endTime":120.792,"body":"with a normal oxygen saturation."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":120.792,"endTime":124.724,"body":"Her initial laboratories are notable"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":120.792,"endTime":124.724,"body":"for a white blood cell count of 10.2,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":124.724,"endTime":126.591,"body":"a hematocrit of 35%,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":126.591,"endTime":129.024,"body":"and a platelet count of 13,000."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":129.024,"endTime":131.941,"body":"Her BUN is 36mg per dl,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":131.941,"endTime":135.516,"body":"and her creatinine is 2.3mg per dl."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":135.516,"endTime":139.706,"body":"During her recent admission for childbirth"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":135.516,"endTime":139.706,"body":"her laboratories were normal."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":139.706,"endTime":142.189,"body":"Although this pregnancy was uneventful,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":142.189,"endTime":145.373,"body":"her three prior pregnancies"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":142.189,"endTime":145.373,"body":"resulted in early losses."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":145.373,"endTime":147.61,"body":"So Cathy,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":145.373,"endTime":147.61,"body":"what additional thoughts do you have"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":147.61,"endTime":149.112,"body":"now that you have more information?"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":149.112,"endTime":151.389,"body":"(Cathy) So, like we summarized,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":149.112,"endTime":151.389,"body":"we have a 27-year-old,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":151.389,"endTime":154.139,"body":"three days post-partum"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":151.389,"endTime":154.139,"body":"with arterial thrombi."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":154.139,"endTime":157.189,"body":"There's nothing else on the history"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":154.139,"endTime":157.189,"body":"or presentations to suggest"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":157.189,"endTime":160.631,"body":"a cause of embolic events,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":157.189,"endTime":160.631,"body":"like A-fib, or atrial fibrillation,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":160.631,"endTime":162.638,"body":"or endocarditis."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":162.638,"endTime":164.792,"body":"Based on the lab, she has mild anemia,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":164.792,"endTime":167.865,"body":"severe thrombocytopenia"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":164.792,"endTime":167.865,"body":"and acute kidney injury."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":167.865,"endTime":169.265,"body":"Do we have a peripheral smear?"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":169.265,"endTime":172.431,"body":"(Charlie) The peripheral smear"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":169.265,"endTime":172.431,"body":"shows thrombocytopenia"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":172.431,"endTime":174.715,"body":"and no evidence of schistocytes."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":174.715,"endTime":176.502,"body":"(Cathy) Okay, so putting"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":174.715,"endTime":176.502,"body":"this all together"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":176.502,"endTime":178.272,"body":"with her history of lost pregnancies"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":178.272,"endTime":181.464,"body":"and the constellation of findings"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":178.272,"endTime":181.464,"body":"associated with this pregnancy,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":181.464,"endTime":184.53,"body":"this really points to"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":181.464,"endTime":184.53,"body":"antiphospholipid syndrome."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":184.53,"endTime":187.097,"body":"That can cause all of the findings"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":184.53,"endTime":187.097,"body":"that were mentioned above,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":187.097,"endTime":189.247,"body":"but there are other disorders"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":187.097,"endTime":189.247,"body":"on the differential"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":189.247,"endTime":191.157,"body":"and a few different ways"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":189.247,"endTime":191.157,"body":"to think about this."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":191.157,"endTime":193.714,"body":"Considering the clotting history"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":191.157,"endTime":193.714,"body":"in the current labs,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":193.714,"endTime":196.813,"body":"I would be most concerned"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":193.714,"endTime":196.813,"body":"about antiphospholipid syndrome."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":196.813,"endTime":198.713,"body":"Fortunately, there's lab testing"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":198.713,"endTime":201.933,"body":"that can help us confirm"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":198.713,"endTime":201.933,"body":"or eliminate this as a diagnosis."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":201.933,"endTime":205.179,"body":"(Charlie) So, that gets us"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":201.933,"endTime":205.179,"body":"to the question, which reads:"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":205.179,"endTime":206.763,"body":"\"Which of the following studies"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":206.763,"endTime":210.295,"body":"will best confirm the underlying etiology"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":206.763,"endTime":210.295,"body":"of her presentation?\""},{"speaker":"(Cathy) Welcome to Episode 15","startTime":210.295,"endTime":214.565,"body":"Option A is anti-cardiolipin"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":210.295,"endTime":214.565,"body":"antibody panel;"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":214.565,"endTime":218.315,"body":"Option B is"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":214.565,"endTime":218.315,"body":"an anti-nuclear antibody, or ANA;"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":218.315,"endTime":222.611,"body":"Option C is Doppler examination"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":218.315,"endTime":222.611,"body":"of her left arm arterial tree;"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":222.611,"endTime":225.861,"body":"Option D is echocardiography;"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":225.861,"endTime":228.994,"body":"and option E is MRI of her brain."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":228.994,"endTime":231.494,"body":"(Cathy) To evaluate for"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":228.994,"endTime":231.494,"body":"antiphospholipid syndrome,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":231.494,"endTime":232.53,"body":"the best lab testing"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":232.53,"endTime":236.224,"body":"is with anti-cardiolipin antibody"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":232.53,"endTime":236.224,"body":"screening panel, or choice A."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":236.224,"endTime":238.144,"body":"This looks for evidence of antibodies"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":238.144,"endTime":241.5,"body":"directed against"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":238.144,"endTime":241.5,"body":"cardiolipin and beta-2 glycoprotein."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":241.5,"endTime":243.81,"body":"Additional testing for lupus anticoagulant"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":243.81,"endTime":245.623,"body":"can be determined by clotting assays,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":245.623,"endTime":247.493,"body":"such as the Russell viper venom time,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":247.493,"endTime":249.793,"body":"the false-positive rapid plasma reagin,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":249.793,"endTime":253.463,"body":"and the APTT, or"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":249.793,"endTime":253.463,"body":"activated partial thromboplastin time."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":253.463,"endTime":255.459,"body":"(Charlie) What do you think of"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":253.463,"endTime":255.459,"body":"the other choices,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":255.459,"endTime":257.575,"body":"and why are they"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":255.459,"endTime":257.575,"body":"less useful in this patient?"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":257.575,"endTime":259.413,"body":"(Cathy) Well, ANA is non-specific,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":259.413,"endTime":263.592,"body":"so that alone won't help you diagnose"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":259.413,"endTime":263.592,"body":"APS, or antiphospholipid syndrome."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":263.592,"endTime":267.91,"body":"Doppler examination of the left arm"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":263.592,"endTime":267.91,"body":"arterial tree and MRI of the brain"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":267.91,"endTime":271.475,"body":"may show presence of thrombosis,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":267.91,"endTime":271.475,"body":"which is likely in this case."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":271.475,"endTime":273.591,"body":"But it doesn't diagnose"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":271.475,"endTime":273.591,"body":"the underlying cause."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":273.591,"endTime":277.357,"body":"Again, in this case we suspect it's"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":273.591,"endTime":277.357,"body":"antiphospholipid antibody syndrome,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":277.357,"endTime":280.157,"body":"and these aren't helpful"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":277.357,"endTime":280.157,"body":"for that diagnosis."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":280.157,"endTime":281.54,"body":"Echocardiogram would be done"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":281.54,"endTime":284.573,"body":"if you suspected there was a"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":281.54,"endTime":284.573,"body":"structural cause of the diffuse clotting."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":284.573,"endTime":287.506,"body":"An example of that would be"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":284.573,"endTime":287.506,"body":"if you were looking for endocarditis."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":287.506,"endTime":289.673,"body":"But again,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":287.506,"endTime":289.673,"body":"this is less likely in this case,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":289.673,"endTime":292.489,"body":"based on the history and physical"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":289.673,"endTime":292.489,"body":"that you presented before."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":292.489,"endTime":294.289,"body":"(Charlie) So, your point is"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":292.489,"endTime":294.289,"body":"that in this case"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":294.289,"endTime":297.273,"body":"not only do we have to address"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":294.289,"endTime":297.273,"body":"the acute symptoms of stroke,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":297.273,"endTime":298.573,"body":"and arterial thrombosis,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":298.573,"endTime":300.606,"body":"but without addressing"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":298.573,"endTime":300.606,"body":"the underlying disease,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":300.606,"endTime":302.922,"body":"we're really not going to"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":300.606,"endTime":302.922,"body":"correct the problem overall."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":302.922,"endTime":304.322,"body":"(Cathy) Yes, exactly."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":304.322,"endTime":306.789,"body":"So, making an accurate diagnosis"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":304.322,"endTime":306.789,"body":"is going to be critical,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":306.789,"endTime":310.002,"body":"but we also want to get"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":306.789,"endTime":310.002,"body":"the hematologists and interventionalists"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":310.002,"endTime":311.632,"body":"involved immediately."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":311.632,"endTime":313.072,"body":"There may be mechanical approaches"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":313.072,"endTime":315.354,"body":"to addressing the stroke"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":313.072,"endTime":315.354,"body":"and the hand ischemia,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":315.354,"endTime":318.311,"body":"and we really want those specialists"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":315.354,"endTime":318.311,"body":"involved early."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":318.311,"endTime":322.071,"body":"With the acute clot, anticoagulation"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":318.311,"endTime":322.071,"body":"would also need to be started immediately."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":322.071,"endTime":324.187,"body":"But in this case,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":322.071,"endTime":324.187,"body":"we have to be very cautious,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":324.187,"endTime":326.253,"body":"because of the severe thrombocytopenia."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":326.253,"endTime":327.953,"body":"(Charlie) The teaching point in this case"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":327.953,"endTime":331.87,"body":"is that the mechanism and the cause"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":327.953,"endTime":331.87,"body":"of arterial thrombosis is different"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":331.87,"endTime":334.24,"body":"than that of venous thromboembolism,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":334.24,"endTime":337.594,"body":"and we need to think of the differential"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":334.24,"endTime":337.594,"body":"and choose appropriate treatments"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":337.594,"endTime":339.851,"body":"based on the clinical presentation."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":339.851,"endTime":342.015,"body":"(Cathy) And for more information,"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":339.851,"endTime":342.015,"body":"you can read about this"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":342.015,"endTime":345.408,"body":"in Harrison's chapter on arterial"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":342.015,"endTime":345.408,"body":"and venous thromboembolism"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":345.408,"endTime":348.038,"body":"and the chapter on"},{"speaker":"(Cathy) Welcome to Episode 15","startTime":345.408,"endTime":348.038,"body":"antiphospholipid syndrome."},{"speaker":"(Cathy) Welcome to Episode 15","startTime":348.038,"endTime":350.291,"body":"♪ (music) ♪"}]}