Ischemic stroke electrocardiogram

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]


An electrocardiogram (ECG) may be performed to determine the underlying etiology such as arrhythmias which may result in clots in the heart that may spread to the brain vessels through the bloodstream. A Holter monitor may be used to identify intermittent arrhythmias.


ECG findings in patients of ischemic stroke may help determine the following:[1][2]

  • Underlying cause for ischemic stroke such as embolic source in atrial fibrillation, ongoing myocardial ischemia, chronic myocardial injury and valvular abnormalities.
  • ECG monitoring in first 24 hours may help determine the new onset or paroxysmal atrial fibrillation.
  • May determine cardiac complications of acute ischemic stroke such as myocardial ischemia or arrythmias.

2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association[3]

Recommendations for Diagnostic Evaluation Referenced studies that support recommendations are summarized in online Data Supplements 1 and 2

Class I
1.     In patients suspected of having a stroke or TIA, an ECG is recommended to screen for atrial fibrillation (AF) and atrial flutter and to assess for other concomitant cardiac conditions. (Level of Evidence: B-R)"
Class IIa
7.    In patients with cryptogenic stroke who do not have a contraindication to anticoagulation, long-term rhythm monitoring with mobile cardiac outpatient telemetry, implantable loop recorder, or other approach is reasonable to detect intermittent AF.(Level of Evidence: B-R)

For AHA/ASA guidelines for cardiac monitoring in patients with ischemic stroke, please click here


  1. Ustrell X, Pellisé A (2010). "Cardiac workup of ischemic stroke". Curr Cardiol Rev. 6 (3): 175–83. doi:10.2174/157340310791658721. PMC 2994109. PMID 21804776.
  2. Togha M, Sharifpour A, Ashraf H, Moghadam M, Sahraian MA (2013). "Electrocardiographic abnormalities in acute cerebrovascular events in patients with/without cardiovascular disease". Ann Indian Acad Neurol. 16 (1): 66–71. doi:10.4103/0972-2327.107710. PMC 3644785. PMID 23661966.
  3. Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D; et al. (2021). "2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association". Stroke. 52 (7): e364–e467. doi:10.1161/STR.0000000000000375. PMID 34024117 Check |pmid= value (help).

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