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Thrombosis and the heart.

The heart is an important site for thrombus formation and cardioembolic events are a frequent cause of stroke. Many cardiac factors may contribute to the risk of cardioembolism. Clinicians must be mindful that those cardiac disorders most likely to cause cardioembolic events include atrial fibrillation, left ventricular dysfunction, valvular heart disease, and structural cardiac abnormalities. The presence of many such conditions mandates the use of specific preventive therapies. Improved diagnostic methods, particularly TEE, now allow more accurate identification and follow-up of potential cardiac sources. Embolus detection monitoring has the potential to allow in vivo identification of embolic events and offers the possibility of objective longitudinal assessment of the impact of therapy. Intravascular ultrasound is an invasive test, but it may eventually allow the most accurate evaluation of the cardiac chambers. New therapies, and new combinations of currently available compounds, may ultimately offer more specific and efficacious alternatives to prevent formation of cardiac thrombus and subsequent cardioembolism. The importance of the heart-brain relationship in stroke has finally been appreciated. Improved understanding of this complex interrelationship will have great impact on clinical practice in the future.