Patent Foramen Ovale

After a year long battle with stroke like symptoms, I've been diagnosed as having complicated migraines.  I'm currently taking aspirin, verapamil and nortriptyline as preventatives and so far have been successful in limiting the number and strength of the episodes.

I recently came across an article indicating that patent foramen ovale has been found in some individuals suffering from migraine. Resulting in small clots being thrown causing TIA type problems. I've had an echocardiogram and numerous EKGs (normal results) as I also have experienced SVT in the past.  The article indicated that echos may miss this tiny abnormality.  In your opinion, should I insist on a TEE from my cardiologist, or is an echo a gold standard for PFO's (like a cath for CAD) for this type of problem?

Thanks for your reply.

[CCF-M.D.-RCJ]

De-De,

Thanks for this interesting question.

The answer is "it depends".  If your cardiologist says that he can clearly see the inter-atrial septum, and no bubbles cross on a bubble study, then a TEE would be unlikely to help.  If the septum is not clearly seen in you (because of you being thin, obese, large lungs, large breast tissue, etc), then a TEE might help to find a PFO.

However, even if a PFO is found, I'm not sure that too many neurologists would recommend closure of the PFO.  This decision would need to be made at a major medical center in conjunction with an interventional cardiologist who specializes in PFO closure.

Hope that helps.

[kuc]

I will be very interested in hearing the doctor's response.  I have had svt since I was 14 and I also have migraines with aura, although this type of migraine runs in my family. (My mom, 3 uncles, and 2 aunts all have the aura w/ their migraines.)  I have had 2 normal echo's and even an ablation attempt for the svt.  Now I wonder if the echo is enough to rule out pfo. Scary!!

[De-De]

I've had a heart murmur since childhood.  Developed SVT and had what the Drs. called "a mild cardiac event" a year before the stroke like episodes began.  I'm in my early 40's but have a strong family history for CAD and migraine.  I mentioned the article to my Internist last week when I saw him and he felt a PFO would have been picked up by an echo.  I dunno, I just feel better bouncing this off someone closer to cardiology.

[Lyn2]

I suffer from migraines, and have SVTs and a PFO.  My PFO was not diagnosed until I had an EP study and ablations.  I have had at least 100 echocardiograms and it was never picked up, until they actually went into my heart with a catheter.  I never heard the connection between migraines and PFOs.  Where did you see that?

[De-De]

Here's a link to the article that I read.  I'll be seeing my cardiologist next month and will definitely talk to her about this.

http://www.headachepainfree.com/news1.htm

[Fibta]

This weekend I had to go to the hospital for what seemed to be a small stroke with symptoms that rapidly receded.  I have a history of migraines with aura.  I watched them discover a patent foramen ovale in my heart with a bubble echocardiogram.

Has there been any further work done on this area that anyone knows of?