Embolic stroke of undetermined source and atrial cardiopathy: Towards a personalized antithrombotic strategy for secondary stroke prevention

Abstract

An 82-year-old hypertensive woman with a history of myocardial infarction is admitted with aphasia and weakness of the right arm and leg. Admission electrocardiogram shows sinus rhythm. During telemetry at the stroke unit, no episodes of atrial fibrillation (AF) are detected. Using transthoracic echocardiography, mitral valve prolapse, moderate-severe aortic stenosis, reduced left ventricular systolic ejection fraction and regional akinesia of the left ventricular wall are identified. Would you consider one of these findings as the cause of her stroke? If yes, which one? Carotid ultrasound reveals a left carotid plaque causing a 40% stenosis without signs of ulceration.