title: Role of routine transthoracic echocardiography in evaluation and management of stroke.
abstract: OBJECTIVE
  To determine the value of routine transthoracic echocardiography in patients with cerebral ischemia without known cardiac disease.
  
  
  METHODS
  The literature from 1990 to 1995 was searched and relevant bibliographies from these papers reviewed. Articles reporting the prevalence and/or risk of stroke for myxoma, vegetation, mitral stenosis, left atrial thrombus, left ventricular thrombus or cardiomyopathy, patent foramen ovale, and atrial septal aneurysm were used. Prevalences and recurrent stroke risk were examined for adult patients less than and greater than 45 years.
  
  
  RESULTS
  Both the prevalence of transthoracic echocardiographic findings and recurrent risk of stroke differ by age. The finding of a patent foramen ovale can be expected in nearly half of younger patients with stroke, whilst transthoracic echo can be expected to yield no relevant lesion in three quarters of patients > 45 years. Warfarin anticoagulation appears beneficial in patients with mitral stenosis, left atrial thrombus, left ventricular thrombus, and left ventricular dysfunction, but is of unproven benefit for patent foramen ovale, atrial septal aneurysm, or in the absence of a risk-associated abnormality.
  
  
  CONCLUSIONS
  For most transthoracic echo findings in stroke, optimal management strategies have not been well defined. Future research is needed to evaluate the appropriate therapeutic approaches.
authors.affiliation: Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Beattie
authors.forename: D J
authors.initials: DJ
authors.lastname: Cohen
authors.forename: W J
authors.initials: WJ
authors.lastname: Manning
authors.forename: P S
authors.initials: PS
authors.lastname: Douglas
mesh_terms: D000328:Adult; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000628:therapy; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D004452:Echocardiography / Q000379:methods; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors