Beyond Atrial Fibrillation: Prioritizing Stroke Evaluation in Resource-Limited Settings

Atrial fibrillation (AF) accounts for the majority of cardioembolic strokes. In addition to AF screening, echocardiography is recommended to evaluate structural heart diseases including congenital anomalies. In resource-limited settings, in-hospital echocardiography for all stroke patients may not be feasible. However, careful assessment of readily available clinical parameters, such as bedside examination, electrocardiography, and chest X-ray, can offer essential clues to guide prioritization of echocardiography in selected patients and facilitate timely management. We present a case of recurrent cardioembolic stroke in a patient with AF, who was later found to have an underlying atrial septal defect, highlighting the importance of a comprehensive approach beyond AF in stroke evaluation.