Cardiac Investigation in Ischemic Stroke Patients That Should be Known in Clinical Practice

Abstract

According to the report of the World Stroke Organization (WSO) in 2022, stroke remains the second-leading cause of death in the world. Cardiac sources of cerebral emboli are responsible for around 15-30% of ischemic strokes. These strokes have a poor prognosis and a high likelihood of catastrophic recurrence. To develop an effective preventive approach, it is essential to determine the underlying etiology of the cerebral embolism. Following a comprehensive diagnostic evaluation, around 30% of strokes remain of unknown origin, with the majority being assigned to an embolic mechanism that indicates a potential cardiac source. By examining clinical symptoms and conducting brain imaging, as well as studying the cerebral vasculature using ultrasonography or magnetic resonance imaging (MRI)/ computed tomography (CT)-based angiography, it is feasible to uncover other reasons or consider the potential involvement of a cardioembolic origin. Atrial fibrillation (AF) is the primary etiology of cardioembolic stroke. Detecting hidden AF is crucial. Baseline electrocardiogram (ECG), serial ECGs, continuous cardiac monitoring within the initial 48 hours, and Holter monitoring exhibit individual detection rates ranging from 4% to 8%. Extended cardiac monitoring utilizing event recorders has demonstrated increased rates of paroxysmal AF detection. Moreover, echocardiography is essential for identifying the anatomical origins of cardiac emboli. However, transthoracic echocardiogram is moderately accurate in diagnosing heart illness, while transesophageal echocardiography is more accurate and is required when no cardiac source has been found in individuals with cryptogenic stroke.