Echocardiography in search of a cardioembolic source

To summarize the role of echocardiography in the treatment of the patient with suspected stroke of transient ischemic attack, a thorough neurologic and hematologic/rheologic evaluation should be performed to determine if there is a noncardiac source (Fig 14). If the neurologic and hematologic workups produce negative findings, then determine whether there is a cardiac history that may suggest a potential embolic source such as an arrhythmia, prosthetic valve disease, significant myocardial infarction, or LV dysfunction. Limited TTE can be performed to identify these risk variables. If the TTE is positive for thrombus or vegetation, the patient should be anticoagulated if there is no contraindication. If the patient is a candidate for anticoagulation, and the TTE failed to identify a potential source, TEE should be performed to search for the presence of complex aortic plaque, LAA clot, or potentially significant PFO. McNamara et al²⁴ reported that TEE on a selective basis was the most cost-effective strategy in the echocardiographic assessment of a recent stroke compared with other echocardiographic strategies. In conclusion, a guided echocardiography approach is cost-effective in stroke assessment. Echocardiography can identify potential cardioembolic sources and stratify high- and low-risk subgroups. Therapeutic treatment of patients with stroke can be individualized on the basis of echocardiographic findings.