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Evaluation of cardiac emboli source
Insights
Identifying the source of cardiac embolism is crucial. Transoesophageal echocardiography (TOE) is ideal for visualizing potential cardiac sources like patent foramen ovale (PFO) and aortic arch atherosclerosis.
Area of Science:
- Cardiology
- Neurology
- Vascular Medicine
Background:
- Evaluating the source of cardiac embolism is a frequent reason for cardiac consultation.
- Prompt identification of cardiac embolism sources is essential for patient management.
Purpose of the Study:
- To determine the yield of diagnostic evaluations in patients referred for cardiac embolism source assessment.
- To identify the most effective diagnostic tools for detecting cardiac sources of embolism.
Main Methods:
- A cohort of 99 patients with suspected cardiac embolism underwent comprehensive evaluation.
- Methods included history, physical examination, ECG, 24-hour Holter monitoring, and contrast-enhanced transoesophageal echocardiography (TOE).
Main Results:
- A potential cardiac source of embolism was identified in 32% of patients.
- Patent foramen ovale (PFO) and aortic arch atherosclerosis were the most common findings.
- 24-hour Holter monitoring did not detect any significant emboligenic arrhythmias.
Conclusions:
- Transoesophageal echocardiography (TOE) is the preferred imaging modality for evaluating cardiac embolism sources.
- TOE effectively visualizes the interatrial septum, left atrial appendage, and aortic arch.
- Routine Holter monitoring is less effective for detecting emboligenic arrhythmias in this population.
Background:
Evaluating the source of cardiac embolism is one of the most frequent reasons for cardiac consultation.
Methods:
In 2003, 99 patients were referred for the evaluation of the source of cardiac emboli. Evaluation included history, physical examination, ECG, transoesophageal echocardiography (TOE) with contrast and 24-hour Holter electrocardiography.
Results:
Altogether, 58 men and 41 women were studied. In 32 patients a possible source of the cardiac emboli was found. Two patients were in atrial fibrillation. Of the patients, 16 had a patent foramen ovale (PFO) and six patients a PFO and atrial septum aneurysm (ASA). Two patients had a thrombus in the left atrial appendage and 14 had severe atherosclerosis in the aortic arch. In eight patients we found two possible cardiac sources of embolism. 24-hour Holter recording did not detect any emboligenic arrhythmias.
Conclusion:
A possible cardiac source of embolism was found in 32% of the patients referred. TOE is the ideal tool to visualise the interatrial septum, left atrial appendage and aortic arch. We advise performing a TOE with contrast in young stroke patients and in older patients with a stroke likely to be caused by an embolism of cardiac origin. 24-hour Holter recording did not detect any emboligenic arrhythmias and should only be done in selected cases.
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