Use of echocardiography in detecting cardiac sources of embolus

Up to 20% of all ischemic strokes are felt to be the result of emboli from the heart. High resolution transthoracic (TTE) and transesophageal (TEE) echocardiography have been the principal diagnostic tools for detecting associated cardiac abnormalities and for guiding medical and surgical approaches to these patients. In addition to identifying the precise location and morphological characteristics of intracardiac masses, echocardiography has improved our ability to predict embolic potential of these masses. Specific cardiac lesions that are predisposed to stroke and are readily identifiable by echocardiography include: cardiac thrombi, valvular vegetations, cardiac tumors, aortic atheroma, atrial septal aneurysm, and regional left ventricular wall abnormalities. Careful interrogation of patients with cerebrovascular accidents has identified a potential cardiac source of embolus in approximately 30%. This is largely due to the advent of TEE, which has provided much better assessment of posterior cardiac chambers including left atrium and left atrial appendage. Use of TEE in identifying a cardiac source of embolus is indicated in patients with stroke who are young, have no apparent cerebrovascular disease, or have recurrent embolic events. Echocardiography is an essential diagnostic tool in evaluating patients with a suspected cardiac source of embolus. TTE and TEE provide invaluable information regarding the majority of cardiac sources of embolus.