Evaluation of cardiac sources of embolism

Cerebrovascular disease is a leading cause of mortality and morbidity .20% of cerebral infarcts are due to cerebral embolism of cardiac origin. Conditions associated with cardiogenic emboli are either rhythm abnormalities such as atrial fibrillation (AF) responsible for 50% , or structural abnormalities .Whereas left ventricle thrombus ,left atrium thrombus ,vegetation , tumor and protruding atherosclerotic plaque are considered as direct sources of embolization , others such as valvular disease , wall motion abnormality , atrial septal defect (ASD) , patent foramen ovale(PFO) , atrial septal aneurysm (ASA) and spontaneous echocardiographic contrast (SEC) are considered as indirect cardiac sources of embolization . In this article evaluation of cardiacsources of embolism and the role of echocardiography are discussed. Though both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) play an important role,TEE appears to be more sensitive in identifying potential abnormalities in patients with suspected cardiac sources of emboli

Hypertension; Chronic Kidney Disease; Atrial Fibrillation and the Newer Anticoagulants

Atrial fibrillation (AF) is a common clinical condition that is associated with increased morbidity and mortality that mainly relates to an embolic stroke. Dominant risk factors for AF are advanced age and hypertension in the absence of mitral valve disease.1 In turn; hypertension and ageing are determinants of the congestive heart failure; hypertension; age; diabetes mellitus; prior stroke or transient ischaemic attack or thromboembolism (CHADS2) criteria for assessing the indication for anticoagulation. In addition; they are important risk factors for chronic kidney disease (CKD). In itself; CKD is an independent risk factor for AF and a higher risk of stroke.2 It is highly likely that a practitioner will encounter older patients with AF and concomitant hypertension and CKD that require anticoagulation therapy. Thus; it is essential for the practitioner to understand the risks and benefits of anticoagulation in older patients with AF; hypertension and CKD