PFO, MVP, arhythmia

I'm a 51 year old woman, active and in good health - except...  In my mid-thirties, I had two TIA's, both short in duration no perm. damage or deficits.  TEE revealed PFO, the size of a pencil eraser.  At that time, I did well on a stress test and Holter.  Three years ago, feeling shortness of breath, had another stress test, flunked the EKG.  Because cardiovascular disease is rampant in my family (all 8 of my mother's brothers, and my fathers brother died of same; my mother had a heart attack at 54 and my brother at 53), I had a catheterization which revealed no blockages but showed a MVP.  And this year, my Holter showed benign arhythmia.   I'm taking Toprol XL, 25 mg per day which really helps my symptoms of MVP, which I'm told is not regurg.  Also taking one baby asperin a day. Used to take 10 mg coumadin per day for PFO, which is what it took to get my level to 2.5.  I stopped taking coumadin 6 years ago because, quite honestly, it scares me - fear of bleed out. and I also feel like, well, 2 little TIA's in fifty years...  Doc says i'm taking a calculated risk.

These are my concerns;  the fact that my stress test EKG is worse than it once was; that the holter moniter now shows something it didn't in the past; What of the synergy of these conditions co-existing?  Is my risk of stroke greatly increased? Is this a dynamic trend? I'm afraid that things are continuing on a negative irreversible path.  By the way, my lipid profile is good, total chol. 166, HDL and LDL within proper range.  Should I reconsider coumadin because of the presence of these three diagnoses?

[Cleveland Clinic]

froptop,

thanks for the post.

Its impossible to make firm recommendations over the internet.  

It is still unclear if patients with a CVA or TIA and a PFO are at an increased risk of having a recurrent event. We usually identify specific risk associated with the PFO such as the amount of shunt and the presence of an atrial septal aneurysm to help determine what type of anticoagulation to put patients on.  There is little evidence to suggest whether ASA or ASA/Plavix or ASA/Coumadin is the best preventive regimen. Also, it is unclear whether closing the defect or medical theraoy is the best treatment option. We do generally close patients with recurrent events despite anticoagulation.  

This is a very unclear field and there are several trials ongoing looking at the best therapies for patients like you. I would discuss these trials with your physician.

good luck

[mnohummingbird]

A related discussion, PFO and blood clots was started.