PFO: The Hole in Your Heart You May Not Know About

May 10, 2024
Nish Patel, MD

PFO: The Hole in Your Heart You May Not Know About

Before you were born, your heart had a tiny opening between the upper chambers (atria). This opening, the foramen ovale, is essential for blood flow in a developing baby. Normally, it closes shortly after birth. But for about 1 in 4 people, that closure never fully happens, leaving a small flap-like opening called a Patent Foramen Ovale (PFO).

So I have a hole in my heart...should I be worried?

For most people, the answer is no. Most people with a PFO live completely normal lives and never even know they have it. PFOs are often discovered during tests for other reasons.

When PFOs Can Be a Concern

While generally harmless, there are situations where PFOs become a concern:

  • Cryptogenic Stroke: In young people who have a stroke with no obvious cause, PFO might be investigated as a potential culprit. Small blood clots can sometimes pass through the PFO, traveling to the brain and causing a stroke.
  • Migraines: Some studies suggest PFOs might be linked to a higher risk of migraine headaches, especially migraines with aura.
  • Decompression Sickness ("The Bends"): Scuba divers with PFOs may be at higher risk for this condition where gas bubbles enter the bloodstream.

What if I'm Concerned?

If you have questions about PFOs, especially related to stroke or migraine risk, talk to your doctor. Here's what they'll likely do:

  • Thorough History and Exam: Understanding your medical history and listening to your heart is the first step.
  • Echocardiogram: This ultrasound of your heart is the best way to diagnose PFO and see its size.
  • Specialized Tests: In some cases, further testing like a "bubble study" might be done to help evaluate blood flow through the PFO.

Treatment: When It's Needed

Most people with PFO won't need treatment. However, in specific circumstances, closure may be recommended:

  • Recurrent Strokes: If a PFO is clearly the cause of repeated strokes despite medication.
  • Severe Migraines: When other forms of treatment have failed.
  • PFO Closure in Divers: Sometimes recommended for divers at risk of decompression sickness.

Closure procedures are minimally invasive, often done with a catheter inserted through a vein.

Living with a PFO

For the vast majority of people, a PFO is simply a quirk of anatomy, no different than some people having different hair colors. But understanding it empowers you to make informed choices:

  • Talk to your doctor: If you have a family history of stroke or suffer from migraines, discuss whether PFO investigation is warranted.
  • Focus on Healthy Habits: A healthy lifestyle always benefits your heart.
  • Informed Decisions: If closure is ever a consideration, weigh the risks and benefits carefully with your doctor.

Key Points:

  • PFOs are common and usually benign.
  • They may sometimes be linked to an increased risk of stroke or migraines in specific situations.
  • Treatment is only needed in rare cases where a PFO is contributing to significant health problems.

Disclaimer: This blog is for informational purposes only and should not replace professional medical advice. Consult your doctor regarding any health concerns or treatment options.

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