CARDIAC EVALUATION OF PATIENTS WITH ISCHEMIC STROKE

Abstract

Objective: To identify the commonest potential cardiac sources of embolism in patients with ischemic stroke.

Methodology: This hospital based descriptive case study was conducted at Khyber Teaching Hospital, Peshawarfrom November 2009 to December 2010 on 150 patients with first ever ischemic stroke. Patients were selected onconvenient sampling technique. All patients with the clinical diagnosis of acute stroke and confirmed by non-contrastComputerized Tomography (CT) scan of brain as ischemic stroke were recruited in the study. Trans- thoracic andTrans- esophageal echocardiography were performed in selected patients in the Cardiology Department. A questionnairewas designed comprising detailed history, general physical examination, neurological, cardiovascular examinationsand relevant investigations. Data was analyzed by SPSS windows version 17.

Results: Study included 150 patients (88 male and 62 female) ranging in age from 18-85 years with mean age of 60years ± 11.20 years. Potential cardiac sources of embolism were present in 45 (30%) patients. Twenty (13.33%)patients had atrial fibrillation due to rheumatic heart disease, 13(8.67%) patients non-valvular atrial fibrillation, 04(2.66%)patients myocardial infarction at the time of stroke, 03(2%) patients had dilated cardiomyopathy, 02(1.33%) patientsinfective endocarditis and one patient each had mitral valve prolapse (0.67%), prosthetic heart valves (0.67%) and leftventricular aneurysm (0.67%).

Conclusion: Potential cardiac sources of cerebral embolism were detected in about one third of patients with ischemicstroke. Atrial fibrillation was the commonest cardiac source of embolism reflecting a high prevalence ofrheumatic fever and rheumatic heart disease in our country.

Key Words: Ischemic Stroke, Cardiac Embolism, Atrial Fibrillation.