The role of echocardiography in the management of stroke

Echocardiography is increasingly being used as a screening test to identify sources of cardiogenic embolism in patients with ischemic stroke or transient ischaemic attack (TIA). However, no consensus exists presently on the utilization of this imaging facility in individuals with stroke.

To evaluate the yield of transthoracic echocardiography in patients with ischaemic stroke with a view to providing guidance in its use in clinical management of stroke.

One hundred and twenty-six consecutive stroke patients with 90 controls were recruited prospectively. Patients were examined echocardiographically for evidence of intramural thrombus, congenital defects, valvular heart disease, wall motion abnormalities and intra-cardiac masses using two-dimensional, m-Mode and Doppler facilities.

Potential cardiac source of emboli (CSE) was identified in 23.0% of the stroke patients. Those who had CSE identified aged 53.0(20.8) years were younger (p=0.0001) than those who did not have CSE, 57.2 (13.5) years. Five (4.0%) patients had rheumatic valvular heart disease with demonstrable clots in the left atrium. On the other hand, four(3.2%) patients had RHD without thrombi seen. Two patients had biventricular thrombi. One of these patients had giant clots within the ventricles and multiple freely mobile thrombi in right ventricle without obvious cardiac structural defect.

Young stroke or transient ischaemic attacks patients who have clinical signs suggesting the heart as the potential CSE should have low threshold for echocardiography. However, there is a need for rationalisation of request for echocardiography where such clinical signs are absent.