Patent foramen ovale and strokes
Carolyn E. Smith BSN, RN

$7.95
Nursing2014 Critical Care
March 2014 
Volume 9  Number 2
Pages 23 - 26
 
  PDF Version Available!

ABSTRACT
MR. L, 43, is sitting at home watching a football game when he experiences bitemporal hemianopsia (visual loss involving the temporal half of each visual field). The visual deficit resolves within a few minutes without any recurrence or additional symptoms. He doesn't have a history of vision problems, but he does have a history of hypertension and migraine headaches. Mr. L occasionally drinks alcohol but has never smoked. Overall, he's in good health.Mr. L follows up with his healthcare provider. An ophthalmologic exam and bloodwork results are normal. Because of Mr. L's history of hypertension, the healthcare provider discusses the possibility of a transient ischemic attack (TIA) and refers him to a neurologist.After examining Mr. L, the neurologist refers him to a cardiologist, who orders a transesophageal echocardiogram (TEE). Mr. L and his wife are shocked to learn that the TEE shows the presence of a "hole in the heart," or a patent foramen ovale (PFO).A foramen ovale is a small oval opening with a flaplike valve located between the right and left atria that's present during fetal development.1 (See Following fetal circulation and A closer look at the foramen ovale.) By the time of birth, when pulmonary circulation is established, a fibrotic process has begun to close the foramen ovale. Complete fibrosis of the opening occurs within the first year or two of life.2For some individuals, however, an opening in the atrial septum persists as a result of improper septal formation (atrial septal defect).1 If large enough, a PFO can cause left-to-right intracardiac shunting of blood (see Picturing PFO).3 Although most patients with a PFO are asymptomatic, complications can occur and increase a patient's risk of cerebrovascular events.2,4It's estimated that 25% to 27% of the population has a PFO, but only a small percentage ever exhibit signs and symptoms of the defect.5Both men and women develop PFO, but the incidence of diagnosis is slightly higher in men. White men

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