Vascular studies

Carotid duplex
Findings: 1-15% diameter reduction of the right ICA. 16-49% diameter reduction of the left ICA. Both vertebral arteries are antegrade and patent.

Transthoracic echocardiogram
Findings: Adequate study. Inferior wall akinesis. Ejection fraction estimated at 45%. Mild concentric hypertrophy. Trace TR. Moderate MR. Left atrium is fibrillating and the size is enlarged. No source of clot identified but the left atrial appendage is not seen completely. Agitated saline does not reveal a right-to-left shunt.