Background: Current guidelines recommend that all patients who are suspected to have a cardio-embolic cause for their cerebral vascular accident (CVA) should receive an echocardiogram. However, there are no clear risk stratification tools to help clinicians identify patients at high risk for having cardio-embolic stroke. As a result, echocardiograms appear to be over utilized and may have a low yield in routine clinical practice. Methods: In our single center study we included patients who were >18 years old and had been admitted from November 2015 to February 2016 to our hospital with an admission diagnosis of Cerebral Vascular Accident (CVA) using ICD-9 code 434.91. Multivariable logistic regression was used to identify factors associated with a greater likelihood of having an echocardiogram ordered as a part of the diagnostic workup. Results: Among 347 patients who were admitted with a diagnosis of CVA, echocardiogram was ordered in 259 (74.6%) patients. In patients who underwent echocardiography, only 3/259 (0.01%) had abnormal findings (e.g., Patent foramen ovale or intracardiac vegetations) that might suggest a cardio-embolic source for their CVA. In the adjusted analyses we found that factors like age, previous history of CVA, findings of atrial fibrillation on electrocardiogram (p-values > 0.05), were not significantly associated with the decision for ordering echocardiograms. Conclusions: Our study shows a low yield of echocardiography to determine an embolic cause in patients who were admitted to the hospital with diagnosis of CVA. Furthermore, no patient-level variables were associated with the likelihood of having an echocardiogram ordered. This may suggest that providers’ decisions to order echocardiograms is random rather than systematic, which itself stems from lack of clear recommendations for clinicians in when to order this test. More clear guidelines in this matter will be helpful to ensure appropriate utilization of this modality in CVA patients.