Every fourth person living in this earth walks around with a hole in his/her heart. Hale, healthy, active and dynamic might not be suitable enough words to describe some of them. These individuals might be athletes involved in high-intensity activities, fighter pilots who risk their lives every day or even astronauts who survive under drastic pressure differences. Most important is that these people don’t even know that they have a hole in their heart and take this secret to their graves until there is a medical complication that highlights the presence of the problem.
Patent Foramen Ovale
Patent foramen ovale (PFO) is a hole between the left and right atria of the heart which exists in each of us before birth. This hole mostly closes sometime soon after birth and when it does not close it is termed as PFO (patent means open). In a mother’s womb, the fetus is supplied with blood-rich oxygen not via the lungs but through a mom’s umbilical cord through the placenta. The foramen ovale helps the blood from the veins to go to the right side of the fetus’ heart from which it then spreads to the left side of the heart. But soon after birth, rise in blood pressure in the left side of the heart automatically causes closure of the foramen ovale without any trouble. When this happens, the blood flows to the lungs to get its supply of oxygen before it goes into the heart from which it then gets distributed all over the body.
The PFO which stays unclosed doesn’t remain open all the time but remains as a flap that stays closed and opens in times of higher pressure than normal in the chambers on the right side of the heart. Even sneezing, forced bowel movements and coughing can cause the PFO to remain open. In times of increased pressure, blood keeps passing over from the right atrium to the left atrium. For most of the individuals with a PFO this movement does not cause any problem and difficulties start when the blood contains a blood clot.
Signs & Symptoms
Most individuals with a PFO don’t suffer from any symptoms and the condition remains undiagnosed unless the patient complains of a severe symptom such as a migraine headache. The presence of a PFO elevates the risk of stroke, transient ischemic attack (TIA) and heart attack. Decreased blood flow to the brain can evoke a TIA whose symptoms are similar to stroke. A TIA is the first sign of a PFO in most cases. Read more about TIA, its signs, symptoms and treatments from the website www.firsteatright.com.
While it is generally 25% of the population that gets caught by a PFA, the risk increases to about 40-50% in patients who experience stroke due to an unknown cause also called as cryptogenic stroke. This is prominently seen in those people who suffer from a stroke before the age of 55. The PFA combines generally with atrial fibrillation to increase the risk of stroke.
Diagnosing a PFO is done primarily through:
Echocardiogram: Ultrasound of the heart is taken to confirm normal blood flow across the heart valves and chambers.
Transesophagealecho (TEE): This is better than a standard echo as the defect is much clearer. A probe with a tiny camera is placed in the esophagus to capture the defective portion precisely.
Bubble study: This is done during an echo or TEE where an IV filled with agitated saline is placed in the arm. This saline creates bubbles and the doctor confirms a PFO if the bubble moves from one side of the heart to the other side.
When an individual has a PFO but suffers from no symptoms or side effects, there is no need for any treatment (no symptoms means there is not much chance for diagnosing the condition in the first place). If in case the patient needs any treatment, any of the below-given ones can help:
Closing the PFO: Logically, any opening that causes a problem should stop disturbing once its closed. But the logic cannot be applied in the case of a PFO. The biggest myth surrounding a PFO is that it must be closed. Closing a PFO is not considered when the patient suffers from one stroke or TIA whose cause is unknown (cryptogenic). Physicians recommend going for a closure only if the patient has suffered from more than one cryptogenic stroke or TIA.
Medications:Drugs never close the hole and the aim of any drug taken for PFO is to prevent a clot from forming in the first place. A person with a PFO who has already suffered from a TIA or stroke must take medications to thin the blood. This prevents blood clots and stroke from occurring again.
AVOID FRAUD. EAT SMART.
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Dietitian & Nutritionist Dr. Nafeesa Imteyaz.