Background: The burden of stroke in young adults appears to have increased significantly over the past few decades. The causes of ischemic stroke are long-standing hypertension, smoking, physical inactivity and poor dietary habit. But, the burden of stroke from rheumatic heart disease in young adults in Ethiopia is not well studied. Methods: A retrospective chart review of all ischemic stroke patients presented to Tikur Anbessa specialized hospital from December 2011 to December 2015. Their demographic data and clinical characteristics were analyzed using descriptive statistics. Result: A total of 161 patients with ischemic stroke were eligible for chart review, of which75 patients (46.6%) were female and 86 patients (53.4%) were male. The median age of patients was 60 years. Among these patients 29 had valvular heart disease, 22 patients (13.7%) had rheumatic heart disease of which 16 patients (73%) were younger than 40 years and 18 patients (82%) had documented a trial fibrillation. Of the RHD patients, there was no risk factor identified other than their cardiac condition for there stroke syptoms.