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Patent Foramen Ovale

AMBULATORY CARE:

What you need to know about a patent foramen ovale (PFO):

The foramen ovale is an opening between the right and left atria (the 2 upper chambers of the heart). The opening looks like a flap. All babies are born with a foramen ovale. The foramen ovale normally closes when the baby takes his or her first breath after being born. It should completely seal by the time a baby is 6 months to 1 year old. When it does not close and seal as it should, it is called a patent (open) foramen ovale. A PFO can last a few years or into adulthood. The cause of PFO is not known.

Patent Foramen Ovale

Signs and symptoms of a PFO:

A small PFO usually does not cause any signs or symptoms. A larger PFO may cause any of the following:

  • A stroke that has no clear cause
  • Decompression sickness when you go SCUBA diving
  • Migraine headache with aura
  • Low oxygen levels that may cause bluish fingernails or lips in babies

Call your local emergency number (911 in the US) for any of the following:

  • You have any of the following signs of a heart attack:
    • Squeezing, pressure, or pain in your chest
    • You may also have any of the following:
      • Discomfort or pain in your back, neck, jaw, stomach, or arm
      • Shortness of breath
      • Nausea or vomiting
      • Lightheadedness or a sudden cold sweat
  • You have any of the following signs of a stroke:
    • Numbness or drooping on one side of your face
    • Weakness in an arm or leg
    • Confusion or difficulty speaking
    • Dizziness, a severe headache, or vision loss
  • You cough up blood.

Seek care immediately if:

  • You are short of breath at rest or more short of breath than usual during exercise.
  • Your lips or fingers are blue or white at rest.
  • Your heart is beating faster than usual or fluttering more than usual.
  • You feel dizzy or faint.

Call your doctor if:

  • You have swelling in your legs or ankles.
  • You have severe abdominal pain or your abdomen is larger than usual.
  • You have a fever.
  • You have chills, a cough, or feel weak and achy.
  • You feel depressed.
  • You have questions or concerns about your condition or care.

Warning signs of a stroke:

The word F.A.S.T. can help you remember and recognize signs of a stroke:

  • F = Face: One side of the face droops.
  • A = Arms: One arm starts to drop when both arms are raised.
  • S = Speech: Speech is slurred or sounds different than usual.
  • T = Time: A person who is having a stroke needs to be seen immediately. A stroke is a medical emergency that needs immediate treatment. Some medicines and treatments work best if given within a few hours of a stroke. Early treatment can decrease the risk of long-term effects of a stroke.
BE FAST SIGNS OF A STROKE

Treatment:

A PFO that does not cause health problems usually does not need to be treated. A large PFO can cause a stroke, migraine headache, or other health problems. The following may be used to prevent a stroke or treat the PFO:

  • Blood thinners help prevent blood clots. Clots can cause strokes, heart attacks, and death. The following are general safety guidelines to follow while you are taking a blood thinner:
    • Watch for bleeding and bruising while you take blood thinners. Watch for bleeding from your gums or nose. Watch for blood in your urine and bowel movements. Use a soft washcloth on your skin, and a soft toothbrush to brush your teeth. This can keep your skin and gums from bleeding. If you shave, use an electric shaver. Do not play contact sports.
    • Tell your dentist and other healthcare providers that you take a blood thinner. Wear a bracelet or necklace that says you take this medicine.
    • Do not start or stop any other medicines unless your healthcare provider tells you to. Many medicines cannot be used with blood thinners.
    • Take your blood thinner exactly as prescribed by your healthcare provider. Do not skip does or take less than prescribed. Tell your provider right away if you forget to take your blood thinner, or if you take too much.
    • Warfarin is a blood thinner that you may need to take. The following are things you should be aware of if you take warfarin:
      • Foods and medicines can affect the amount of warfarin in your blood. Do not make major changes to your diet while you take warfarin. Warfarin works best when you eat about the same amount of vitamin K every day. Vitamin K is found in green leafy vegetables and certain other foods. Ask for more information about what to eat when you are taking warfarin.
      • You will need to see your healthcare provider for follow-up visits when you are on warfarin. You will need regular blood tests. These tests are used to decide how much medicine you need.
  • Antiplatelets , such as aspirin, help prevent blood clots. Take your antiplatelet medicine exactly as directed. These medicines make it more likely for you to bleed or bruise. If you are told to take aspirin, do not take acetaminophen or ibuprofen instead.
  • Cardiac catheterization is a procedure used to close the PFO through a catheter (thin tube). This procedure may be used if you had a stroke. The catheter is placed into an artery in your groin and guided up to your heart. A device is then used to close the hole. This helps prevent another stroke caused by a blood clot.
  • Surgery may be used to stitch the PFO closed.

Improve your heart health and help prevent a stroke:

If you had a stroke or are at risk for stroke or heart disease, healthcare providers will give you instructions. The following is general information:

  • Prevent blood clots. Change your body position or move around often during the day. Move and stretch in your seat several times each hour if you travel by car or work at a desk. Move your legs by tightening and releasing your leg muscles while sitting. If you have to be on a long flight, get up and walk every hour. Drink water often during the flight.
  • Maintain a healthy weight. Being overweight can increase your risk for high blood pressure, diabetes, and coronary artery disease. Ask your healthcare provider what a healthy weight is for you. Ask him or her to help you create a weight loss plan if you are overweight.
  • Do not smoke. Nicotine and other chemicals in cigarettes and cigars can cause heart, blood vessel, and lung damage. Ask your healthcare provider for information if you currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you use these products.
  • Limit or do not drink alcohol as directed. Alcohol can increase your risk for high blood pressure, diabetes, and coronary artery disease. Alcohol also increases your risk for a stroke. If you choose to drink alcohol, limit your daily and weekly amounts. In general, men should limit alcohol to 2 drinks per day. Women should limit alcohol to 1 drink per day. Limits depend on your age and heart health. Your healthcare provider will tell you if it is okay for you to drink alcohol, and how much is okay.
  • Eat heart-healthy foods. Eat more fresh fruits and vegetables. Eat fewer canned and processed foods. Replace butter and margarine with heart-healthy oils such as olive oil and canola oil. Other heart-healthy foods include walnuts, whole-grain breads, low-fat dairy products, beans, and lean meats. Fatty fish such as salmon and tuna are also heart healthy.

  • Limit sodium (salt). Sodium can make your body retain (hold) extra fluid. Extra fluid makes your heart work harder. You may need to limit sodium to 2,300 milligrams (mg) each day. Your healthcare provider will tell you how much sodium is okay for you each day. A dietitian can help you create a meal plan that has the right amount of sodium.

  • Exercise regularly to help increase your blood flow. Walking is a good low-impact exercise. Talk to your healthcare provider about the best exercise plan for you. Ask your healthcare provider if you need to avoid strenuous activities. This is usually only needed if the PFO is causing symptoms.
    Walking for Exercise

Follow up with your doctor as directed:

You may be referred to a cardiologist or hematologist for more tests or treatment. Write down your questions so you remember to ask them during your visits.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Further information

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