cardioembolism

Cardioembolism refers to embolic events in which material from the heart or its chambers travels through the arterial circulation and occludes a distant vessel. It is a major cause of ischemic stroke and can affect multiple organs if emboli migrate elsewhere in the body.

Common cardiac sources include atrial fibrillation with left atrial appendage thrombus, left ventricular thrombus after myocardial infarction or in dilated cardiomyopathy, valvular heart disease (for example rheumatic mitral stenosis or prosthetic valves), and infective endocarditis with vegetations. Rare sources include cardiac tumors (such as myxoma) and acute aortic pathological processes. Emboli may consist of thrombus, vegetations, tumor fragments, or air in uncommon situations.

Pathophysiology involves the formation of a cardiac thrombus or other material that dislodges during the cardiac cycle, enters the arterial system, and lodges in a downstream vessel. The resulting occlusion causes ischemia in the affected organ, most often the brain, but systemic embolization can involve kidneys, spleen, limbs, or mesenteric vessels.

Diagnosis requires confirmation of an ischemic event and identification of a cardiac source. Evaluation typically includes brain imaging (CT or MRI) to define stroke, transthoracic or transesophageal echocardiography to detect intracardiac thrombus or valvular disease, and prolonged ECG monitoring to detect paroxysmal atrial fibrillation. Vascular imaging helps exclude noncardiac causes.

Management emphasizes prevention of recurrence and treatment of the index event. Acute stroke management follows standard guidelines for ischemic stroke. Long-term strategies depend on the underlying source and may include anticoagulation (eg, for atrial fibrillation or LV thrombus) or, in select cases, surgical or percutaneous interventions such as left atrial appendage closure.