As I arrived to John Hopkins I was relieved and fearful at the same time. It was a long, cold bouncy ride in that ambulance with much anxiety. What was in store? I felt like they had performed every test possible already and every vein had been used at this point except for my legs. They’d be used later! Within an hour a nurse practitioner arrived to my room and said we think we know what’s wrong. You have a hole in your heart between the upper right atrium and left atrium called a PFO. Instead of all of your blood going from your right heart to your lungs then back up through the left heat. Your blood is going from your right heart directly to your left heart and almost completely bypassing your lungs. It’s called shunting. We don’t know how large it is but it has to be significant to show a decrease in an oxygen level. Most people present symptoms as minimal, fatigue and shortness of breath. Or they have strokes due to the abnormal shunting. I was to see the doctor in the morning. I was left again with my thoughts.
What is a PFO?
A patent foramen ovale (PFO) is a defect in the septum (wall) between the two upper (atrial) chambers of the heart. Specifically, the defect is an incomplete closure of the atrial septum that results in the creation of a flap or a valve-like opening in the atrial septal wall (see illustration). A PFO is present in everyone before birth but seals shut in about 80 percent of people.
With each heart beat or when a person with this defect creates pressure inside his or her chest - such as when coughing, sneezing, or straining during a bowel movement - the flap can open, and blood can flow in either direction directly between the right and left atrium. When blood moves directly from the right atrium to the left atrium, this blood bypasses the filtering system of the lungs (the lungs actually do dissolve tiny blood clots). If debris is present in the blood, such as small blood clots, it now passes through the left atrium and can lodge in the brain, causing a stroke, or another organ, such as the heart, eyes, or kidneys.
What are the Symptoms of a PFO
Although present in about one in five adults, PFOs usually cause no symptoms at all. Far less than 1 percent has a stroke or other outcome that results in the need to have the PFO closed.
What causes a PFO?
A PFO is congenital, meaning it is a defect that is inborn or exists at birth. Stated another way, the defect is an abnormality, not a disease. The septum between the two atrium of the heart developed normally before birth but the flap did not seal completely after birth.
The doctor came in first thing in the morning and explain what a PFO was, but that they needed to out rule some other structural defects. More tests! For a PFO to even be problematic is very uncommon. In addition mine not only was problematic, but it was causing significant shunting when I was upright! I found out I had a very rare conditon known as platpnea-orthodeoxia. Meaning that when I stood up or walked the minimal shunting that was occurring when I was laying flat during all my tests(echo, cat scans, TEE ect..) opened up to be the size of a quarter due to the normal changes of heart pressures. Why it occurs in some is unknown. In 2002 there were only 50 documented cases and the last figure I read was 2,500 depending on what medical journal you read. All is known is that you have to have a large PFO and a atrial septal anuersym(meaning a flappy septal wall that divides your right heart from your left). I had both. This condition is so rare that even the most experienced doctor would miss this condition. It has to be caught by continuous monitoring and checking a walking oxygen level. So, what was happening in my case is that when I sat in certain positions or walked over a matter of seconds. I started shunting, which caused my heart rate to soar, then came my shortness of breath and then after a few hours my heart was so irritated that arrhythmias would occur. Mostly just a super high heart rate; as high as 200 and some premature ventricle beats and atrial beats. Premature beats can be very common, but they can also be an indicator that something is wrong. In my case my body needed more oxygen so my heart was pumping harder and faster to get it. So, my surgery was scheduled and I was on my way to a quick recovery; or so I thought!
What is a PFO?
A patent foramen ovale (PFO) is a defect in the septum (wall) between the two upper (atrial) chambers of the heart. Specifically, the defect is an incomplete closure of the atrial septum that results in the creation of a flap or a valve-like opening in the atrial septal wall (see illustration). A PFO is present in everyone before birth but seals shut in about 80 percent of people.
With each heart beat or when a person with this defect creates pressure inside his or her chest - such as when coughing, sneezing, or straining during a bowel movement - the flap can open, and blood can flow in either direction directly between the right and left atrium. When blood moves directly from the right atrium to the left atrium, this blood bypasses the filtering system of the lungs (the lungs actually do dissolve tiny blood clots). If debris is present in the blood, such as small blood clots, it now passes through the left atrium and can lodge in the brain, causing a stroke, or another organ, such as the heart, eyes, or kidneys.
What are the Symptoms of a PFO
Although present in about one in five adults, PFOs usually cause no symptoms at all. Far less than 1 percent has a stroke or other outcome that results in the need to have the PFO closed.
What causes a PFO?
A PFO is congenital, meaning it is a defect that is inborn or exists at birth. Stated another way, the defect is an abnormality, not a disease. The septum between the two atrium of the heart developed normally before birth but the flap did not seal completely after birth.
The doctor came in first thing in the morning and explain what a PFO was, but that they needed to out rule some other structural defects. More tests! For a PFO to even be problematic is very uncommon. In addition mine not only was problematic, but it was causing significant shunting when I was upright! I found out I had a very rare conditon known as platpnea-orthodeoxia. Meaning that when I stood up or walked the minimal shunting that was occurring when I was laying flat during all my tests(echo, cat scans, TEE ect..) opened up to be the size of a quarter due to the normal changes of heart pressures. Why it occurs in some is unknown. In 2002 there were only 50 documented cases and the last figure I read was 2,500 depending on what medical journal you read. All is known is that you have to have a large PFO and a atrial septal anuersym(meaning a flappy septal wall that divides your right heart from your left). I had both. This condition is so rare that even the most experienced doctor would miss this condition. It has to be caught by continuous monitoring and checking a walking oxygen level. So, what was happening in my case is that when I sat in certain positions or walked over a matter of seconds. I started shunting, which caused my heart rate to soar, then came my shortness of breath and then after a few hours my heart was so irritated that arrhythmias would occur. Mostly just a super high heart rate; as high as 200 and some premature ventricle beats and atrial beats. Premature beats can be very common, but they can also be an indicator that something is wrong. In my case my body needed more oxygen so my heart was pumping harder and faster to get it. So, my surgery was scheduled and I was on my way to a quick recovery; or so I thought!
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