Related Experiment Video
Updated: Jul 10, 2025
Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
[Embolic stroke of undetermined source - ESUS: a new challenge for the cardiologist]
Letizia Riva1, Giuseppe Di Pasquale2
1U.O.C. Cardiologia, Ospedale Maggiore, AUSL Bologna.
Insights
Embolic stroke of undetermined source (ESUS) requires thorough cardiac evaluation to find hidden causes like atrial cardiomyopathy or heart failure. While direct oral anticoagulants show no superiority over aspirin, they may benefit select patients with specific cardiac conditions.
Area of Science:
- Cardiology
- Neurology
- Vascular Medicine
Context:
- Embolic stroke of undetermined source (ESUS) presents a diagnostic challenge.
- Cardiologists play a crucial role in identifying occult cardioembolic sources.
- Subclinical atrial fibrillation is often undetectable by standard ECG monitoring.
Purpose:
- To outline the diagnostic work-up for ESUS.
- To highlight potential cardiac etiologies of ESUS.
- To discuss the role of anticoagulation in managing ESUS.
Summary:
- Potential cardiac causes of ESUS include atrial cardiomyopathy, left ventricular dysfunction, heart failure, aortic plaques, and patent foramen ovale.
- Randomized trials have not shown direct oral anticoagulants (DOACs) to be superior to aspirin for ESUS.
- DOACs may be considered for select ESUS patients with heart failure or thrombotic aortic plaques, despite limited trial evidence.
Impact:
- Improved diagnostic strategies for ESUS.
- Personalized treatment approaches for patients with stroke of undetermined origin.
- Guidance for clinicians on anticoagulation therapy in complex ESUS cases.
Abstract:
Embolic stroke of undetermined source (ESUS) is a new clinical entity which requires an accurate diagnostic work-up. The involvement of the cardiologist in this challenge is of paramount importance as in many cases an occult cardioembolic source is detectable. In the absence of subclinical atrial fibrillation detectable by prolonged ECG monitoring, potential causes of ESUS include atrial cardiomyopathy, left ventricular dysfunction or heart failure, aortic plaques and patent foramen ovale. The assessment of a causal relationship between these cardiac abnormalities and ESUS is often a difficult challenge and the randomized clinical trials performed so far failed to demonstrate a superiority of direct oral anticoagulants (DOAC) over aspirin. In selected individual patients with heart failure in sinus rhythm with high CHA2DS2-VASc score, or aortic plaques with thrombotic component, oral anticoagulation with DOAC might be considered even in the absence of evidence from randomized clinical trials.
More Related Videos
Related Concept Videos
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for...