Etiological spectrum of cardioembolic strokes in a tertiary care hospital of India: Analysis of one year data

Background: Traditionally rheumatic heart disease with mitral stenosis and atrial fibrillation has been the common mechanism of cardioembolic strokes in India. However, with the increase in life span and higher detection and development of cardiac diseases, the frequency and etiologic spectrum of cardioembolic stroke in an Indian hospital may be changing. Methods: The case records of patients admitted in the year 2020 were analyzed for the presence of risk factors and identified stroke mechanisms. Results: Among 538 patients of ischemic strokes, cardioembolic source was identified in 156 (29.8%) patients. Five major cardiac sources of embolism were identified: Coronary artery disease (with acute or remote myocardial infarction) 56/156 (35.89%), non valvular atrial fibrillation, 34/156(21.79%), post cardiac intervention 28/156 (17.94%), left atrial cardiomyopathy 20/156 (12.8%), and rheumatic heart disease 13/156 (8.3%). Conclusion: Coronary artery disease, non valvular atrial fibrillation, post intervention stroke and left atrial cardiomyopathy are emerging as common causes of cardioembolic strokes. Rheumatic heart disease continues to be an important but less frequent cause of cardioembolic strokes.