Ischemic stroke: the cardiac workup

The cardiac workup of stroke often includes a 24 hours Holter and an echocardiography looking for cardiac sources of emboli (atrial fibrillation (AF), intracardiac thrombus, mitral stenosis, recent myocardial infarction, endocarditis, dilated cardiomyopathy...) which would lead to a change of treatment (secondary prevention) aiming at decreasing the risk of recurrence. In case of a stroke with AF, the secondary prevention strategy is well defined (anticoagulants). It is less clear for the other causes. The diagnostic yield of these examinations is limited and there is a lack of consensus in their utility. This systematic review tries to sum up current guidelines. It appears that these examinations should rather be targeted than performed systematically.