A patent foramen ovale is a small flap-like opening between the atria that fails to seal after birth and is present in about one in four adults. It is usually harmless, but a clot from the veins can cross it and cause a stroke, mainly in younger patients.
Key symptoms
- Usually no symptoms
- Stroke or TIA symptoms with no other cause found
- Migraine with aura in some patients
- Rarely, low oxygen when sitting up that improves lying down
What you find on exam
- Usually a normal heart exam
- Neurologic exam for focal deficits
- Leg exam for deep vein thrombosis
Tests
- Transthoracic echo with agitated saline (bubble study)
- Transesophageal echo to define the anatomy before closure
- Brain MRI and vessel imaging after a stroke
- Rhythm monitoring to exclude atrial fibrillation; leg vein ultrasound
Treatment basics
- No treatment when found by chance
- Antiplatelet therapy such as aspirin after a stroke
- Device closure for patients aged 60 or younger with a PFO-related stroke
- Anticoagulation if a clot or venous thrombosis is found
Red flags
- Sudden weakness, facial droop or trouble speaking
- Stroke in a young patient with no clear cause
- Sudden low oxygen in a patient with a known PFO
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.