The heart-brain connection: How a common heart defect affects your stroke risk

People are often surprised to learn that 1 in 4 adults have a small hole in their heart. While that may seem serious, most people don’t know they have this common heart defect, and it usually isn’t a cause for concern.

But in a few people, this small opening—known as patent foramen ovale or PFO—can make a difference in their health, especially if they experience a stroke. When a person younger than 50 has a stroke without any risk factors, PFO is often the hidden cause.

The connection between PFO and stroke

Everyone has a small valve or opening at the top of the heart between the right and left sides before they’re born, but it usually closes on its own after birth. If it stays open, PFO can allow blood to flow the wrong way in your heart—directly from the right side to the left side—bypassing the lungs.

Most of the time, this incorrect blood flow doesn’t affect your body. But it can be an issue when it comes to how your body manages blood clots.

“We have small blood clots that form in our bodies all the time, but our lungs act like a sponge and absorb them, so they don’t cause a problem,” said Bao Le, DO, an interventional cardiologist on the medical staff at Baylor Scott & White Medical Center – College Station. “But, if for a split second, the PFO opens and allows a blood clot to flow into the left side of the heart, instead of the lungs, it can travel to other parts of your body.”

If the blood clot ends up in your brain, it can block a blood vessel. And that can lead to a stroke.

When to talk to your doctor about PFO

For many people, a stroke without a known cause, called a cryptogenic stroke, is the first and only sign of PFO. That’s why it’s important to talk with your doctor and get to the source of your stroke.

If the cause is PFO, a procedure to close off the PFO is usually recommended. PFO closure is a safe, effective procedure that gives you a way to avoid taking long-term blood thinners while greatly reducing the risk of having another stroke.

“If you’ve had a stroke, especially if you’re young, and nobody can tell you why, ask for a bubble study or a transcranial Doppler,” said Robert Jay Widmer, MD, PhD, an interventional cardiologist on the medical staff at Baylor Scott & White Medical Center – Temple. “A bubble study uses ultrasound imaging and injects a saline solution to create bubbles in the heart. If those bubbles move from the right to the left side, there’s a high probability that the person has PFO.”

People with a known PFO should also talk to their doctor if they’re involved in one specific sport—scuba diving. The pressure changes in scuba diving can increase the risk of air bubbles going through the hole in the heart, traveling up to the brain and leading to a stroke.

“Everyone looks at me funny in the clinic when I ask if they scuba dive,” Dr. Widmer said. “But if someone has a PFO and wants to pursue scuba diving, I recommend they have their PFO closed.”

Another potential benefit of choosing PFO closure is an improvement in migraines. About 30-40% of people with PFO experience migraines, and many of them report fewer headaches after PFO closure.

“We don’t have a great randomized trial yet that shows closing PFO can definitively cure migraines,” Dr. Widmer said. “But we think there’s a subset of patients who have a certain type of migraine that PFO could help.”

What to expect with PFO closure

PFO closure is a minimally invasive procedure that inserts a thin tube called a catheter into a vein in the groin and guides it into the heart. The catheter carries a special device that’s used to close the PFO opening.

“The PFO closure device is like a sandwich with two buns,” Dr. Le said. “Once in place in the heart, we deploy a bun on one side and then a bun on the other side, with the PFO sandwiched in the middle.”

Typically, PFO closure takes less than an hour, and most people go home the same day or next day. After three to six months, people are able to stop blood thinners and continue taking aspirin only.

“A stroke can be a devasting event in someone’s life, but PFO closure can be life-changing for them,” Dr. Le said. “After the procedure, they don’t have to worry about having another stroke in the future.”

Caring for your heart and brain together

From PFO to stroke, understanding the connection between your heart and your brain lets you get the right care for your needs.

“The risk factors for stroke are the same as for heart disease, so if you’ve had one, you want to reduce your risk for the other,” Dr. Widmer said. “There are also many intricate ways the heart and the brain are tied together.”

As you navigate your options for PFO and stroke, talk to your primary care physician, look for a center that performs a high volume of PFO closures and make sure your neurologist is connected to a cardiologist.

With multiple specialists working together, you’ll be able to better care for your heart and brain as a team. And that gives you the power to reduce your risk of cardiovascular disease moving forward.

Want to know more about your heart health? Take our heart risk quiz