Document Detail

Cardiac workup of ischemic stroke.
MedLine Citation:
PMID:  21804776     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Stroke is the leading cause of disability in developed countries and the third cause of mortality. Up to 15-30% of ischemic strokes are caused by cardiac sources of emboli being associated with poor prognosis and high index of fatal recurrence. In order to establish an adequate preventive strategy it is crucial to identify the cause of the embolism. After a complete diagnostic workup up to 30% of strokes remain with an undetermined cause, and most of them are attributed to an embolic mechanism suggesting a cardiac origin.There is no consensus in the extent and optimal approach of cardiac workup of ischemic stroke. Clinical features along with brain imaging and the study of the cerebral vessels with ultrasonography or MRI/CT based angiography can identify other causes or lead to think about a possible cardioembolic origin.Atrial fibrillation is the most common cause of cardioembolic stroke. Identification of occult atrial fibrillation is essential. Baseline ECG, serial ECG('s), cardiac monitoring during the first 48 hours, and Holter monitoring have detection rates varying from 4 to 8% each separately. Extended cardiac monitoring with event loop recorders has shown higher rates of detection of paroxysmal atrial fibrillation.Cardiac imaging with echocardiography is necessary to identify structural sources of emboli. There is insufficient data to determine which is the optimal approach. Transthoracic echocardiography has an acceptable diagnostic yield in patients with heart disease but transesophageal echocardiography has a higher diagnostic yield and is necessary if no cardiac sources have been identified in patients with cryptogenic stroke with embolic mechanism.
Xavier Ustrell; Anna Pellisé
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Current cardiology reviews     Volume:  6     ISSN:  1875-6557     ISO Abbreviation:  Curr Cardiol Rev     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2011-08-01     Completed Date:  2011-11-10     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  101261935     Medline TA:  Curr Cardiol Rev     Country:  United Arab Emirates    
Other Details:
Languages:  eng     Pagination:  175-83     Citation Subset:  -    
Stroke Unit, Neurology Department, Joan XXIII University Hospital, Tarragona, Catalonia, Spain.
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