Patent Foramen Ovale (PFO)

What is Patent Foramen Ovale (PFO)

A foramen ovale is a hole between the upper chambers (right atrium and left atrium) of the heart. Before you are born, it is normal to have this hole in your heart.

The hole allows blood to circulate through the body without having to go through the lungs. After your birth, when you are able to breathe, you do not need the foramen ovale and it usually closes. If the hole does not close, it is called a patent foramen ovale (PFO).

PFO is a common condition. Most people do not know they have this hole and they do not have any health problems caused by it.

What are the causes?

The cause of this condition is not known.

What increases the risk?

You are more likely to develop this condition if:

  • You have a family history of PFO.
  • You also have other heart disease that is present at birth (congenital heart disease).

What are the signs or symptoms?

In most cases, there are no symptoms of this condition. Possible rare symptoms include:

  • Stroke caused by a blood clot.
  • Transient ischemic attack (TIA). This is a “warning stroke” that causes stroke-like symptoms that go away quickly.
  • Migraine headaches.

How is this diagnosed?

This condition may be diagnosed based on:

  • A physical exam and your medical history.
  • Echocardiogram. This test uses sound waves to produce images of the heart.
  • Transesophageal echocardiogram (TEE). This type of echocardiogram is performed by placing a probe in the part of the body that moves food from the mouth to the stomach (esophagus).
  • Electrocardiogram (ECG). This test identifies changes in the electrical activity of the heart.
  • Cardiac MRI. This is an imaging technique that is used to visualize the heart, if further images are needed after TEE.

How is this treated?

Usually, no treatment is needed. If your condition is associated with symptoms or blood clots, you may need:

  • Medicines to prevent blood clots and strokes (anticoagulant or antiplatelet medicines).
  • A surgical procedure to close the hole (transcatheter closure).

Follow these instructions at home:

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You have a fever.
  • You have frequent or severe headaches.

Get help right away if:

  • Your skin turns blue.
  • You have chest pain or difficulty breathing.
  • You have any symptoms of stroke. “BE FAST” is an easy way to remember the main warning signs of stroke:
    • B – Balance. Signs are dizziness, sudden trouble walking, or loss of balance.
    • E – Eyes. Signs are trouble seeing or a sudden change in vision.
    • F – Face. Signs are sudden weakness or numbness of the face, or the face or eyelid drooping on one side.
    • A – Arms. Signs are weakness or numbness in an arm. This happens suddenly and usually on one side of the body.
    • S – Speech. Signs are sudden trouble speaking, slurred speech, or trouble understanding what people say.
    • T – Time. Time to call emergency services. Write down what time symptoms started.
  • You have other signs of stroke, which may include:
    • A sudden, severe headache with no known cause.
    • Nausea or vomiting.
    • Seizure.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

  • A patent foramen ovale is a hole between the upper chambers (right atrium and left atrium) of your heart. The cause of this condition is not known.
  • You may not know that you have a hole in your heart, and you may not have any health problems associated with it.
  • Usually, no treatment is needed for this condition unless it is associated with symptoms or blood clots.
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