The role of echocardiography in patients after ischemic stroke

Therapy of acute phase of ischemic central vascular accident is focused on immediate actions to suppress the severity of damage with the earliest possible initiation of reperfusion strategy together with initiation and maintenance of adequate therapy to prevent further cerebral reinfarctions. The key factor for adequate and effective secondary prevention is elucidation of the etiology of ischemic central vascular accident because the risk of brain reinfarction is the highest in the first weeks after the primary event. The exclusion of potential cardiac or vascular sources of embolization into the cerebrovascular system is essential in choosing adequate secondary prevention. Origins of embolization are important to identify because they represent different thromboembolic risks. Transesophageal echocardiography is a frequently used diagnostic method after ischemic stroke. However, because of the variability in the frequency of cardiac findings between studies of similar populations, the lack of correlation between cardiac abnormalities thought to be associated with each other and cryptogenic stroke, it is unclear if routine use of echocardiography in patients with cryptogenic stroke should be recommended. Its routine use to elucidate the causes of stroke has a role in some patient groups, especially in young patients who present with cryptogenic stroke and no cardiovascular risk factors, as well as in the setting of a deep venous thrombosis, and older patients with a suspicion for structural heart disease or left ventricular or left atrial thrombus.