17326 Patent Foramen Ovale Pfo

Overview

A patent foramen ovale (PFO) is a small, flap-like opening in the wall between the two upper chambers of the heart (the atria). Everyone has this opening before birth, and it normally closes shortly after birth. In about one in four people, it stays open. This is called a PFO. In most cases, a PFO does not cause any problems and many people never even know they have one. However, in some people, the opening can allow small blood clots to pass through the heart, which may increase the risk of a stroke.

Yes, a PFO is very common. Studies suggest that roughly one in four people have one. Many people live their entire lives without it causing any issues.

Anyone can have a PFO. It is present from birth, so it affects people of all ages, genders, and backgrounds. It is usually discovered by chance when a heart test is done for another reason.

Symptoms

Common symptoms

• There are usually no symptoms at all.
• Some people may experience migraine headaches, especially migraines with aura (visual or other sensory disturbances), though the link to PFO is not fully proven.
• The first symptom might be a stroke or a transient ischemic attack (TIA), which is a temporary blockage of blood flow to the brain.

Symptoms in children

• Most children with a PFO have no symptoms.
• In newborns, a PFO can sometimes be part of another heart condition, but on its own it is usually harmless.
• If symptoms occur, they are usually related to other heart or lung issues, not the PFO itself.

Symptoms in older adults

• Most older adults with a PFO still have no symptoms.
• If a blood clot passes through the PFO, it could cause a stroke or TIA, which can occur at any age but is more concerning in older adults who may have other stroke risks.
• Some older adults may have spells of dizziness or brief weakness, but these are not directly caused by the PFO unless a clot has traveled.

Causes

Main causes

• A PFO is a birth difference. Before birth, the foramen ovale is a normal opening that lets blood bypass the lungs, because the baby receives oxygen from the mother's placenta.
• After birth, the opening normally closes within the first few months. If it does not close completely, it remains as a PFO.
• The exact reason why some PFOs do not close is not fully understood, and it is not something you did or did not do.

Risk factors

• There may be a genetic tendency, though no strong inherited pattern is known.
• People who are prone to blood clots (for example, due to deep vein thrombosis or certain clotting disorders) may have a higher risk of a clot crossing through a PFO.
• There are no lifestyle factors that directly cause a PFO.

When to see a doctor

See a doctor urgently if:

• If you have sudden weakness, numbness, trouble speaking, vision loss, or severe headache, call your local emergency number immediately. These are signs of a stroke.
• If you have repeated unexplained episodes of dizziness or fainting, seek medical attention promptly.

Book a routine appointment if:

• If you have experienced a stroke or TIA and are being investigated, your doctor may look for a PFO.
• If you have migraine with aura and are concerned about a possible connection to a PFO, talk to your doctor during a routine appointment.

Diagnosis

A PFO is usually diagnosed with an ultrasound scan of the heart (echocardiogram). Often, a bubble contrast study is used, where a small amount of agitated salt water is injected into a vein. The doctor watches on the ultrasound to see if tiny bubbles pass from the right side to the left side of the heart through the opening.

Tests that may be done

• Transthoracic echocardiogram (TTE) – an ultrasound of the heart through the chest.
• Transesophageal echocardiogram (TOE) – an ultrasound probe passed into the esophagus for clearer pictures.
• Bubble contrast study – often done together with an echocardiogram to see if bubbles cross the heart.
• Magnetic resonance imaging (MRI) or computed tomography (CT) scan – may be used in some cases, though less commonly.

What to expect at your appointment

If a PFO is found, your doctor will discuss what it means for you. You may be referred to a heart specialist (cardiologist) or a specialist in brain blood vessels (neurologist) if it was found in relation to a stroke. The specialist will help determine if the PFO is likely related to your symptoms and whether any intervention is appropriate.

Treatment

For most people with a PFO, no treatment is needed. If a PFO is found in someone who has had a stroke with no other clear cause, doctors may recommend medication to prevent blood clots, or in some cases, a procedure to close the PFO.

Self-care at home

• Follow a heart-healthy lifestyle: eat a balanced diet, stay physically active, and maintain a healthy weight.
• Avoid smoking and limit alcohol.
• Manage other health conditions such as high blood pressure, diabetes, and high cholesterol.
• Stay well-hydrated and move regularly, especially during long flights or car trips, to help prevent blood clots.

Medical treatments

Medical treatment for PFO-related stroke risk usually involves blood-thinning medicines (sometimes called anticoagulants or antiplatelet therapy). These medicines help reduce the chance of blood clots forming and traveling to the brain. The choice of medication is individualised, and your doctor will discuss the benefits and risks with you. In some cases, if you have had a stroke and a PFO is thought to be the cause, your doctor may recommend a procedure to close the hole.

When is surgery considered?

Closure of a PFO is usually done with a minimally invasive procedure called catheter-based closure. A thin tube is inserted into a vein and guided to the heart, where a small device is placed to block the opening. This does not require open-heart surgery. Open surgery is rarely needed and is only considered in very complex situations.

Living with this condition

If you have a PFO and no symptoms or complications, you can live your life normally. There is no restriction on work, exercise, travel, or daily activities. If you have had a stroke or TIA, your recovery and daily limits will depend on your individual situation. Your healthcare team will guide you.

Lifestyle tips

• Know the signs of a stroke, and make sure your family or close friends know them too.
• Avoid prolonged periods of sitting without movement. If you are on a long flight, walk around or move your legs periodically.
• Stay hydrated and wear compression stockings if advised by your doctor, especially for long travel.
• Keep your regular check-ups with your doctor, especially if you take medication.

Diet and exercise

A heart-healthy diet rich in vegetables, fruits, whole grains, and lean proteins is recommended. Eat foods low in saturated fats, salt, and added sugars. Regular exercise, such as brisk walking, swimming, or cycling for at least 150 minutes per week, is good for your heart and overall health. Always check with your doctor before starting a new exercise programme.

Mental health and emotional wellbeing

A PFO itself does not cause anxiety, but if you have had a stroke or TIA, it is completely normal to feel anxious, worried, or low. Talk about your feelings with your doctor, family, or friends. If you experience persistent sadness, anxiety, or trouble sleeping, let your healthcare team know. They can provide support or refer you to a mental health professional.

Prevention

You cannot prevent having a PFO because it is present from birth. However, you can reduce the risk of blood clots that might pass through a PFO. This includes staying physically active, not smoking, keeping a healthy weight, and managing underlying conditions like high blood pressure or diabetes. If your doctor has prescribed medication to prevent clots, take it as directed.

Screening programmes

There is no routine screening for PFO in healthy people. It is usually found when a heart test is done for other reasons, such as an echocardiogram after a stroke, heart murmur, or other cardiac symptoms.

Complications

If left untreated

• The main potential complication is an increased risk of stroke, because a blood clot can pass from the right side to the left side of the heart and travel to the brain.
• Some research suggests a possible link between PFO and migraines, especially migraines with aura, but this is not fully established.
• In rare cases, a PFO may be associated with other heart or lung conditions, but this is uncommon.

Long-term outlook

The outlook for people with a PFO is generally excellent. Most people with a PFO will never experience any problems. Even if you have had a stroke, medical and procedural treatments are effective in reducing the risk of future events. Many people return to a full and active life. Your doctor will work with you to create a plan that fits your own needs.

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