Many diseases with specific indications for specific treatment such as patent foramen ovale (PFO), papillary fibroelastoma, myxoma, endocarditis, and intracardiac thrombi are diagnosed by echocardiog- Transthoracic echocardiography is preferred over TEE for the detection of left ventricular (LV) thrombus, but TEE is superior to transthoracic echo- cardiogram in detecting left atrial thrombus, aortic atheroma, prosthetic valve abnormalities, native CLINICAL STATEMENTS AND GUIDELINES Kleindorfer valve abnormalities, atrial septal abnormalities, and A systematic review that included 65 studies concluded that transthoracic echocar- diography in the second harmonic is cost-effective relative to TEE.56 TEE findings will change manage- ment in 1 in 7 patients with ESUS.57 7. Randomized trials show that longer heart monitoring in patients with cryptogenic stroke results in higher detection rates for AF. A randomized study of an insertable cardiac monitor versus conventional follow- up in patients with cryptogenic stroke found that by 6 months AF had been detected in 8.9% of patients in the insertable cardiac monitor group versus 1.4% of patients in the control group (95% CI, 1.9 21.7; A randomized study of patients 55 years of age who had had a cryptogenic ischemic stroke or TIA within the previous 6 months found AF lasting 30 seconds in 16.1% in the interven- tion group monitored with a 30-day event triggered recorder compared with 3.2% in the control group who had standard monitoring, including 24-hour Repeated Holter electrocardiographic monitoring in patients 60 years of age with recent stroke signifi- cantly increases the likelihood of AF detection over Improvement in patient outcomes with long-term rhythm monitoring has not been established. 8. 