Patent foramen ovale in the heart - the hidden culprit causing stroke in young people

MSc. Dr. Hoang Tien Trong Nghia, Head of the Department of Neurology, Military Hospital 175, said the patient was admitted in a state of dizziness and vertigo. Thanks to timely treatment with thrombolytic drugs, the symptoms quickly improved. However, the initial diagnostic imaging showed abnormal signs, making the doctor suspect an underlying cause behind the stroke at such a young age.

The results of the in-depth screening showed that the patient had a patent foramen ovale in the heart - the culprit in the formation of blood clots causing cerebral infarction. The interventional cardiologists successfully closed the hole, preventing the risk of recurrence. After two weeks of rehabilitation and supportive therapy, the patient fully recovered and returned to daily work.

Patent foramen ovale (PFO) is a congenital heart defect in which a small hole between the two atria fails to close spontaneously after birth. This hole is necessary for blood circulation during pregnancy and usually disappears after birth. However, about 25-30% of the population survives into adulthood, most of which do not cause symptoms and the patient can live a normal life without knowing it. PFO is often only discovered incidentally through echocardiography or when it causes complications such as stroke due to a blood clot passing through the hole from the right heart chamber to the left, then traveling up to the cerebral artery.

"The presence of a patent foramen ovale is a common cause of stroke in young people, but it has not been noticed in the past," said Dr. Nghia. The reason is often that stroke symptoms in young people can progress very discreetly, causing them to not go to a specialized hospital for timely screening.

Regarding this deformity, Associate Professor, Dr. Nguyen Huy Thang, Vice President of the Vietnam Stroke Association, Head of the Department of Cerebrovascular Diseases at People's Hospital 115, recalled a special case 17 years ago. The 38-year-old female patient was admitted to the hospital because of sudden complete paralysis of the left side of her body, right before her wedding day. What caught the attention of the doctors was that she was completely healthy, without high blood pressure, diabetes or underlying cardiovascular disease.

The survey recorded a complete blockage of the middle cerebral artery, the team decided to intervene by injecting thrombolytic drugs directly into the blood clot - when this technique was just beginning to be researched and implemented in Vietnam. After two hours, the blood clot was completely dissolved, the next morning the patient recovered almost completely.

The problem was to find the cause of stroke in a young person with no risk factors. Transcranial ultrasound results showed the presence of a patent foramen ovale in the heart - a malformation that can account for up to 40% of "idiopathic" stroke cases in people under 45 years old. This result was further confirmed by transesophageal echocardiography. The patient then underwent intervention to close the foramen ovale at People's Hospital 115, ending the risk of recurrence.

According to Associate Professor Thang, most cases of PFO do not require treatment. Intervention only arises when this defect is the cause of stroke. With a rate of about 25% of the normal population, equivalent to 25 million Vietnamese people having a patent foramen ovale, most of them do not cause any problems. More than 95% of people with PFO do not have complications and do not need intervention.

PFO is not a common cause of stroke in the general population, because the patients are mainly (over 85%) older. Therefore, in stroke patients over 50 years old, few people raise the issue of "finding the cause of PFO". At this age, atrial fibrillation should be considered if a cardiac thromboembolic cause is suspected.

Therefore, there is no recommendation to screen for PFO in normal people, to find the 25 million Vietnamese people who have this defect but have never had a stroke. Currently, it is recommended to screen for PFO when and only when there are enough factors, including: the patient has had a stroke (not targeting people who have never had a stroke); stroke patients are young under 45 years old; no suitable cause of the stroke can be found.

Experts say that screening and detecting the cause of stroke at specialized medical facilities is a key issue in managing and controlling stroke prevention. Everyone needs to have regular health check-ups. If the main culprits causing stroke in general such as high blood pressure, diabetes, atrial fibrillation... are detected, long-term medication is needed to control. Do not stop taking medication on your own when you feel well or buy medication according to an old prescription. Avoid stroke risk factors by stopping smoking, limiting alcohol, controlling weight, having a reasonable diet, and exercising regularly.

Go to the emergency room immediately if you have any of the following symptoms: numbness or weakness in the face, arms, or legs. Be careful if the symptoms occur on one side of the body, mouth distortion, sudden inability to speak or difficulty speaking, blurred vision, headache, dizziness, or loss of balance.

PV (synthesis)

Source: https://baohaiphong.vn/lo-bau-duc-trong-tim-thu-pham-giau-mat-gay-dot-quy-o-nguoi-tre-521389.html