The risks of blood clots with PFO

[honeywell]

Thanks for taking the time to review my question. I am a 26 female. In July 2001 I had a stroke and it was later discovered that I have a 2mm (quite small) PFO. The dr's said that the PFO was the most likely cause of my stroke. In Oct, I had a TEE and it was then decided to start me on coumadin. I am now on 8mg daily. I am cautious about being on the coumadin with it's potential side effects. What are the risks of having another clot pass through the PFO? Are they high enough to remain on the coumadin indefinately? I am just trying to gater enough information to weigh both the pros and cons of both.

Also, can palpations be associated with PFO. I have been getting them in incresing frequency and I have times where my heart races out of control...sometimes mt rate is upwards of 150. I have also fainted twice in the past two weeks...quite unexpectely and suddenly. I see me cardiologist in mid January or is this something I should see my family doctor about.

It's quite unsettling to be having so many troubles at such a young age. Any information that you could provide would be greatly appreciated. Thanks so very much for your time.

Janet

[CCF-M.D.-CRC]

Dear janet,
The risks of stroke with a small patent foramen ovale (PFO) are somewhat controversial but given the fact that you have had a stroke this would certainly be a high probability that is was due to the PFO.  The palpitations and fainting are concerning and something you should talk to your cardiologist about. He/she may send you to an 'electrophysiologist' who is a specialist in the area of heart rhythms.  There is no association between PFO and heart arrhythmias.

The best treatment for the PFO will depend somewhat on what is to be done for the heart rhythms.  If an ablation is being considered for tretment of the heart rhythm then I would wait on having the PFO closed.  Once the rhythms are under control I would discuss with your cardiologist closure of the PFO with a 'clamshell' device that can be inserted through a catheter.  This would allow you to stop taking the coumadin on a long term basis.

[debra21784]

Sorry to hear about your stroke.At age 46 I had a stroke from cardiac problems as well My clot orginated in the heart and travelled to my brain to an area that controlled not only my locomotion but my speech.It has taken two years to recover moderate function.I too am on coumadin to prevent reoccurrence of a stroke.Aside from the monthly blood levels to check my clotting time it is not bad.
It has been my understanding from all the research articles I have read and the stroke experts around the country thatI have been in contact with that, if you have had a stroke you will probably remain on coumadin life long to decrease the risk of another.It also sound as if you are having some sort of arrythmias as well.Has your M.D. suggested an EP study or at least a event or holter monitior to see what the electrical activity looks like ?
Are they planning to repair the PFO?
There was a December article in the New England Journal of Medicine on PFO and it specificly discusses the use of coumadin ,repair etc of PFO.You can access this journal on line through Medscape.Com.

[Dawn]

At age 29, I also had a stroke for no known reason other than a PFO.  Mine was also small and I was on coumadin for a year.  After that year, I had follow up check ups with my neurologist and cardiologist, and they thought the only way to take me off the coumadin is to have the PFO repaired.  There was a new procedure to have a Cardoseal put in through a catheter.  I went in to have this procedure done last March.  When they went in, they noticed that my PFO had closed on its own during the course of that year.  I was releived that this had happened but still a little scared.  Therefore, I am taking 325 mg of asprin a day just to be on the safe side.  I am glad not to be on coumadin anymore.  I think you should talk to all of your doctors to get thier opinion and think about what you want to do for the rest of your life.  I certainly didn't want to take coumadin forever and that is why I elected to have the Cardioseal procedure.  I was just extremely lucky to have it close on its own!

[Tracy-lee]

Janet, I also am trying to find info on PFO and the risks of stroke when the PFO is small. I have only just been diagnosed with a  small PFO. Before I knew I had this I had lots of episodes of palpatations and also pain that would run up my neck into  my ear that seemed to come from the chest area. The doctor put this all down to indigestion but now I am not convinced that this pain is not related to the PFO.I am going to get lots of second opinions as I am only 33 and have four very active children and a husband, that need me around for a long time!
If I find any info I will send it on. Take care.
Tracy-lee

[kakie]

Hi, I am a 37 year old who runs a daycare out of my home and have 3 kids of my own older than 10.  Last year I had a TIA on the last day of school in June and it terrified me.  Five weeks later I found out that I have a P.F.O. which has never been discovered until then adn that the believe that it was a blood clot that happened.  I am scheduled for to have a cardioseal occluder put in in April in Toronto, Ontario I am having this done by putting it in through my leg artery.  Is there anyone out there that has had this done recently and can tell me alittle about it from a personal opion.  I am very nervous about it, I want to know how long my leg will be sore?  Also I am nervous about different heart palipatations that I will have later.  I also heard that people suseptable to migraines have increased headaches after that.  Has anyone suffered that?  I Have taken 2.5 weeks off work after that is that enough?  Any answers will be greatly appreciated.

[hwstock]

I'm interested in what you decide, because I too am considering the closure operation.

I had a brainstem stroke March-7-2002.  While there is some
damage to my brain, and my speech and handwriting are challenged, I am lucky and am getting better.

The stroke was due to a clot lodging in the arteries of the brainstem, and was detected by MRI (though it was not seen in the CT scan).  It is unclear if the clot moved more that once, before I finally had the major symptoms. I felt stiffness in the neck for a week before.  Before the stroke, I was coughing and quite sick with a cold, but was forced, by circumstances, to work during the illness.

I am 47, have no real family history of stroke, have intermediate blood pressure (110/70 after mild exercise),
have a low pulse (45-50 resting), do not smoke, am fit, and
have very low cholesterol. I have no observable plaque.  I
was climbing mountains 5 days before, and this stroke was
quite a surprise.

What I do have, is a PFO (patent foramen ovale).  The PFO
was discovered TEE (transesophageal echocardiogram) after
the stroke.  The size was determined by contrast echocardiography - the "bubble test" showed a total of about
5 bubbles crossing the atria, after many squirts through the
system.  I'm told this is a very small hole, and my stroke
was unusual.  It is difficult to correlate this "bubble size" with the diameter in mm (used elsewhere to evaluate
risk).  In addition, I have a history of migraine with aura,
which (I understand) is correlated with PFO and with stroke.

The admitting doctor has me on 4 mg/day of  Coumadin (Na
Warfarin); there is talk of moving to aspirin in 3 months.

In 1984, I recognized that I had a tendency to run, quite
suddenly, out of steam when I was exerting a lot (as in
running at 10000').  I went to a doctor, who had me run
until I felt the sudden exhaustion come on; he determined I
might have mitral prolapse.  Unfortunately, that doctor took
in a new job, during my testing period, so the tests were
never completed.  That diagnosis stood as the "explanation"
until my TEE (which showed I did not have mitral prolapse).

A friend (an MD) has sugested I have a closure operation -- possibly open-heart surgery.