 I then performed a risk/benefit/alternative analysis with benefits being more definitive exclusion of intracardiac thrombus as well as assessment for intracardiac shunts; alternatives being transthoracic echo imaging, which she had already had, with an inherent false negativity for this indication as well as empiric medical management, which the patient was not interested in; risks including, but not limited to, and the patient was aware this was not an all-inclusive list, of oversedation from conscious sedation, risk of aspiration pneumonia from regurgitation of stomach contents, risk of oropharyngeal, esophageal, oral, tracheal, pulmonary and/or gastric perforation, hemorrhage, or tear. 
I then performed a risk / benefit / alternative analysis with benefits being more definitive exclusion of intracardiac thrombus as well as assessment for intracardiac shunts ; alternatives being transthoracic echo imaging , which she had already had , with an inherent false negativity for this indication as well as empiric medical management , which the patient was not interested in ; risks including , but not limited to , and the patient was aware this was not an all - inclusive list , of oversedation from conscious sedation , risk of aspiration pneumonia from regurgitation of stomach contents , risk of oropharyngeal , esophageal , oral , tracheal , pulmonary and/or gastric perforation , hemorrhage , or tear .