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This Stroke Risk Factor Hides in Your Heart

By Himanshu Agarwal, MD April 26, 2024 Posted in: Heart Health

Could you be walking around with a tiny hole in your heart and not know it? That’s the case for one in four people, due to an anatomic condition that starts before birth. 

Every baby is born with a small hole in their heart called a foramen ovale. It serves an important purpose. Because a baby’s lungs do not function until birth, the developing fetus depends on the mother’s oxygenated blood, which is delivered through this hole between the right and left atriums. 

What is a Patent Foramen Ovale (PFO)?

For three out of four babies, the foramen ovale seals completely a few months after birth. But for one out of four, it remains open. Called a patent foramen ovale (PFO), it usually causes no noticeable symptoms and goes undetected – unless a stroke occurs.  

A stroke can happen for many reasons and it’s sometimes considered cryptogenic, meaning the cause is simply unknown. But in some cases, a tiny blood clot can cross through the PFO and travel to the brain, causing a stroke. 

A PFO raises stroke risk for people from age 18 to 60. The good news is there’s a simple surgical solution which can help prevent future strokes in people who have a PFO. 

Finding and Treating PFOs

Whether someone has a PFO usually remains a mystery, unless doctors looking for a cause after a stroke – especially in younger patients – discover it. The definitive test is a special echocardiogram called a transesophageal echocardiogram (TEE). During a TEE, tiny bubbles are injected into the bloodstream to see if they cross through the PFO.  

At CHI Health’s Heart-Brain Clinic, the first of its kind in Nebraska, an interventional cardiologist and neurologist evaluate these patients together. If a PFO is found, it can be closed with a tiny device called an occluder which was approved by the FDA in 2017.

It’s a minimally-invasive outpatient procedure which starts with a small incision in the groin. Using a catheter, the occluder device is threaded up through blood vessels to the heart, where it is placed over the PFO. The patient is typically sent home within four hours and returns to normal activities immediately, with a reduced risk of suffering a debilitating, life-altering stroke. 

Reducing Stroke Risk

Many people don’t realize that after a stroke, the risk of having another stroke is highest in the first few months. Treating a PFO during this time can help to reduce this risk. Studies have shown that PFO closure can reduce the risk of recurrent stroke by up to 50%, when compared to medical treatment alone.*

Conversely, multiple studies have shown that treating a patient with this type of stroke with medications alone is not enough because medications can only reduce risk factors, such as high blood pressure and high cholesterol. 

Closing the PFO with the occluder device is a one-and-done solution that is safe, effective and  covered by many insurance plans. 

Know Stroke Signs

It’s also important to know and never ignore stroke symptoms. Especially in younger people, stroke can mimic the pain of a migraine. Symptoms to watch for include: 

  • Sudden loss of balance
  • Sudden change in vision
  • Face drooping, uneven smile
  • Arm numbness or weakness
  • Slurred speech, difficulty speaking
  • Severe headache with no known cause

If you have any of these symptoms, call 911. The fastest possible evaluation and treatment can save your life and preserve precious brain functioning, because time is brain. If you have questions or concerns , talk to your provider. We help you understand and reduce your stroke risk. 


*Hart RG, Diener HC, Coutts SB, et al. Closure of patent foramen ovale for prevention of recurrent stroke in patients with cryptogenic stroke and patent foramen ovale: a meta-analysis of randomized trials. JAMA. 2017;318(11):1033-1041. doi:10.1001/jama.2017.11840

Himanshu Agarwal, MD
Himanshu Agarwal, MD

Dr. Himanshu Agarwal is an Interventional Cardiologist and currently serves as Director of the Structural Heart Program at CHI Health Heart and Vascular Institute in Omaha, Nebraska.

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