Cardiology is the medical specialty focused on the heart and the cardiovascular system. It involves the diagnosis, treatment, and prevention of conditions affecting the heart and blood vessels. These conditions include coronary artery disease, heart failure, arrhythmias (irregular heartbeats), and valve disorders. The field covers a broad spectrum, from congenital heart defects present at birth to acquired conditions like heart attacks.
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Many people who require percutaneous closure live for years, or even decades, without knowing they have a heart defect. Unlike a broken bone or a severe infection, a hole in the heart does not always cause immediate pain. The symptoms can be subtle, creeping up slowly as a person ages, or they can appear suddenly in the form of a medical emergency like a stroke. Understanding the symptoms and risk factors is crucial because early detection can prevent serious complications down the road.
The body is remarkably adept at adapting to imperfections. If a hole in the heart is small, the heart might work harder to compensate, and the person might feel perfectly normal. However, as the body ages or faces stress, that compensation can fail. Recognizing the signs—whether they are chronic fatigue or unexplained neurological issues—is the first step toward getting the right treatment.
For many patients, the first sign of a heart defect is not a heart symptom at all, but a brain symptom. The connection between the heart and the brain is direct. If a hole exists in the heart, it allows blood to bypass the lungs. The lungs normally act as a filter, trapping small blood clots before they enter the main circulation. If a clot skips the lungs through a PFO or ASD, it can travel straight to the brain.
A “cryptogenic” stroke is a stroke with no obvious cause. The arteries are clear, the heart rhythm is normal, and cholesterol is fine. In these cases, doctors look for a PFO. If a clot crosses the hole in the heart, it causes what is known as a paradoxical embolism. The symptoms are those of a standard stroke: sudden numbness, difficulty speaking, vision loss, or weakness on one side of the body. For younger people who suffer a stroke, a PFO is a leading suspect.
There is a strong, though not fully understood, link between PFOs and severe migraine headaches, especially those with “aura” (visual disturbances like flashing lights). While having a PFO does not guarantee migraines, studies indicate that people who suffer from severe migraines are much more likely to have a PFO than the general population. Some theories propose that the lungs should filter tiny chemicals or micro-clots that cross the PFO and irritate the brain.
While PFOs are often linked to stroke, ASDs (missing wall tissue) are more likely to cause physical symptoms related to heart function. As a person with an ASD gets older, the extra blood flowing to the right side of the heart begins to take a toll. The right heart chamber stretches and weakens, and the pressure in the lungs can rise.
The most common physical symptom is exercise intolerance. A person might notice that they get winded much faster than their peers. They might assume they are just out of shape or getting older. However, the shortness of breath persists even with training. They might discover themselves needing to stop and rest after climbing one flight of stairs or feeling unable to keep up during a family walk.
When the heart chambers stretch due to extra blood flow, it disrupts the heart’s electrical system. This leads to arrhythmias, or irregular heartbeats. Patients often describe the condition as a fluttering sensation in the chest, a skipped beat, or a racing heart. This is frequently atrial fibrillation. While palpitations can be scary, they are a helpful warning sign that prompts patients to see a doctor.
It is very common for conditions like Patent Foramen Ovale (PFO) or small Atrial Septal Defects (ASD) to be completely asymptomatic in childhood and early adulthood. This is often called a “silent” defect. A person might play sports, work a demanding job, and live a full life without ever suspecting a heart issue.
The defect is often found incidentally. This means a doctor might order an echocardiogram (heart ultrasound) for a completely different reason—perhaps to check a heart murmur heard during a routine physical or to evaluate high blood pressure—and discover the hole by accident. For these patients, the diagnosis can be a shock because they feel healthy. However, even if there are no symptoms, the defect can still pose risks, particularly regarding blood clots.
For many patients, the first sign of a heart defect is not a heart symptom at all, but a brain symptom. The connection between the heart and the brain is direct. If a hole exists in the heart, it allows blood to bypass the lungs. The lungs normally act as a filter, trapping small blood clots before they enter the main circulation. If a clot skips the lungs through a PFO or ASD, it can travel straight to the brain.
A “cryptogenic” stroke is a stroke with no obvious cause. The arteries are clear, the heart rhythm is normal, and cholesterol is fine. In these cases, doctors look for a PFO. If a clot crosses the hole in the heart, it causes what is known as a paradoxical embolism. The symptoms are those of a standard stroke: sudden numbness, difficulty speaking, vision loss, or weakness on one side of the body. For younger people who suffer a stroke, a PFO is a leading suspect.
There is a strong, though not fully understood, link between PFOs and severe migraine headaches, especially those with “aura” (visual disturbances like flashing lights). While having a PFO does not guarantee migraines, studies indicate that people who suffer from severe migraines are much more likely to have a PFO than the general population. Some theories propose that the lungs should filter tiny chemicals or micro-clots that cross the PFO and irritate the brain.
While PFOs are often linked to stroke, ASDs (missing wall tissue) are more likely to cause physical symptoms related to heart function. As a person with an ASD gets older, the extra blood flowing to the right side of the heart begins to take a toll. The right heart chamber stretches and weakens, and the pressure in the lungs can rise.
The most common physical symptom is exercise intolerance. A person might notice that they get winded much faster than their peers. They might assume they are just out of shape or getting older. However, the shortness of breath persists even with training. They might discover themselves needing to stop and rest after climbing one flight of stairs or feeling unable to keep up during a family walk.
When the heart chambers stretch due to extra blood flow, it disrupts the heart’s electrical system. This leads to arrhythmias, or irregular heartbeats. Patients often describe the condition as a fluttering sensation in the chest, a skipped beat, or a racing heart. This is frequently atrial fibrillation. While palpitations can be scary, they are a helpful warning sign that prompts patients to see a doctor.
Why do these holes happen? In most cases, defects like ASDs and PFOs are congenital, meaning they are present at birth. The development of the heart in the womb is a complex process involving folding and dividing tubes. Occasionally, this process is interrupted or incomplete.
Genetics plays a role. If a parent or sibling has a congenital heart defect, the likelihood of having one increases. Certain genetic syndromes, such as Down syndrome, are also strongly associated with heart defects like ASDs. However, for many people, there is no clear genetic link; it is simply a random occurrence during fetal development. Environmental factors during pregnancy, such as exposure to certain viral infections or medications, can also increase the risk, but often the cause remains unknown.
A common question is, “If I was born with this, why am I only having symptoms now at age 40?” The answer lies in the heart’s changing dynamics. A young heart is resilient and compliant. It can handle the extra volume of blood leaking through a hole without complaining.
However, as we age, the heart muscle naturally becomes stiffer. Blood pressure (hypertension) often develops. These factors increase the pressure on the left side of the heart. Higher pressure on the left forces more blood through the hole into the right side (in an ASD) or forces the flap open more frequently (in a PFO). Essentially, the “leak” becomes worse as the heart gets older. This phenomenon explains why a defect that was silent in childhood can cause heart failure or stroke in middle age.
Understanding the risks of leaving a defect open helps in making the decision for percutaneous closure. While not every hole requires closure, high-risk features typically influence the decision to proceed with treatment.
For PFOs, the main risk is recurrent stroke. If a person has already had a stroke caused by a clot crossing the PFO, the risk of it happening again is significant without closure or strong blood-thinning medication. For ASDs, the risk is long-term damage to the heart and lungs. Over decades, the extra blood flow can cause pulmonary hypertension (high blood pressure in the lungs), which is a serious and irreversible condition. It can also lead to permanent enlargement of the right heart and chronic heart failure.
Send us all your questions or requests, and our expert team will assist you.
Yes, absolutely. Roughly 25% of the entire population has a PFO, and the vast majority will never have a stroke. Closure is generally only recommended if you have already had a stroke or have high-risk features.
Generally, yes. Symptoms related to ASDs, such as shortness of breath and fatigue, tend to appear or worsen in the 40s and 50s as the heart muscle stiffens and compliance decreases.
Stress doesn’t physically pry the hole open, but actions that increase pressure in the chest—like straining, heavy lifting, or severe coughing (Valsalva maneuver)—can force the flap open momentarily, allowing blood to cross.
No. Shortness of breath has many causes, including asthma, obesity, or anxiety. However, if it is unexplained and persistent, a heart evaluation, including an echocardiogram, is often warranted.
Doctors do not typically screen for PFO just because of migraines. However, if you are being evaluated for other heart issues, you can mention your migraine history. Closure is mainly approved for stroke prevention, not migraine relief, though some patients report improvement.
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