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Hole in heart found
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Hole in heart found

I just learned yesterday that a small hole was found between the upper chambers of my heart.  I believe this is called an atrial septal defect, but was never told the official medical term.  This was found on a routine echocardiogram for evaluation of pvcs as I have had an increase in them the last month or so.  I had an echo 2½ years ago and the hole was not picked up then.  I am confused by this.  The tech that called me with the results downplayed it saying that the hole was small and I have an otherwise structurally normal heart and valves.  My ejection fraction was 65%. She said that they would note it in my file.  Everything I have read online says that the hole should be repaired.  I have asked for further explanation from my doctor, but he hasn't called back yet.  Shouldn't there be other tests run?  Do all atrial septal defects require repair/surgery? I have had dizziness on and off for years.  Could this be the cause?  The tech that called with my results did say that it was unlikely that the hole was causing the pvcs since they come from the lower chamber and the hole is in the upper chamber.  Is that true?  Should I seek out a second opinion?
Avatar_dr_m_tn
Dear inquiringmind41,

I can understand your reaction to the news of a possible 'hole in the heart'. You have commenced the research process and that will place you in a good position for your visit to your next doctors visit (which I would recommend to properly follow up this result). Rather than a '2nd opinion' it is important that you meet with your doctor or visit a cardiologist so that the echocardiogram report can be interpreted in the context of your medical history.

As you know, a hole in the heart that involves the top chambers or 'atria' is called an atrial septal defect. They may also be called a patent foramen ovale or PFO. The foramen ovale is a normal heart structure that we all rely on when we are babies in the womb, and which allows circulation of blood from the right to the left side of the heart (necessary because our lungs are not expanded in the womb). After we are born, the hole usually closes. However, up to 30% of patients will have a residual opening or 'patency' of the foramen ovale. This is not necessarily a problem because PFO's are small and the amount of blood crossing the PFO does not place the heart under strain. A PFO can however be a problem in young patients who present with a stroke or stroke like symptoms because this can mean that the PFO is enabling clots to travel from the right to the left side of the heart. In this instance, closure of the PFO may be recommended.

Answering your other questions:
Shouldn't there be other tests run? This depends upon your history, examination and other investigations you may have already had. It also depends upon additional findings on your echo such as the size of the heart chambers and heart function.

Do all atrial septal defects require repair/surgery? No. Surgery or closure is only recommended in the presence of complications arising from the ASD. Surgery and other means of closure are not without risk and therefore the benefits of closure need to significantly outweigh any risks associated with closure.

I have had dizziness on and off for years.  Could this be the cause?  It's possible but overall unlikely. Of course that depends again on your medical history, the nature of your dizziness, and findings on examination / other investigations. A cardiologist would be helpful in putting all of this together.

I think it is less likely that the atrial septal defect is causing your PVC's. More important for your PVC's is an understanding of your ventricular or pump function and the exclusion of other triggers such as excessive caffeine, alcohol, electrolyte disturbances (usually screened on routine bloods), thyroid dysfunction, and coronary disease. Once again, a cardiologist would be helpful in reviewing these findings with you.

Take care and good luck.
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