Transthoracic echocardiography in young patients with acute retinal arterial obstruction

Objective: To report the transthoracic echocardiographic findings in young patients presenting with acute retinal arterial obstruction, given their clinical risk status for cardioembolic disease. Design: Case series. Setting: Four North American tertiary hospital centres. Patients: Eleven patients less than 45 years of age presenting with acute retinal arterial obstruction who underwent transthoracic echocardiography. Outcome measure: Anticoagulation therapy or cardiac surgery. Results: Echocardiography showed abnormalities in five patients (45%). Five of the 11 patients were at high risk for cardioembolic disease on the basis of a history of risk factors or the presence of a cardiac murmur on presentation, or both. Three (60%) of the five had abnormal findings on echocardiography; all three required anticoagulation therapy or cardiac surgery. Of the six patients at low risk two (33%) had abnormal echocardiograms; neither required anticoagulation therapy or surgical intervention. Conclusions: All the patients who required anticoagulation therapy or cardiac surgery based on the findings on transthoracic echocardiography were deemed to be at high risk for cardioembolic disease. This emphasizes the importance of clinical risk stratification in the systemic evaluation of young patients presenting with acute retinal arterial obstruction.