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What Causes Postpartum Cryptogenic Stroke?

Posted on Mon, 20 Jul 2015

Question: I am 42 years old, previously healthy, female, and 19 months postpartum. I had a cryptogenic stroke on feb 22, a pfo was found on tee, and closed via catheter with gore helex on May 28. Two weeks later (after going back to work), I have a ton of afib and flutter. Your thoughts? Could this be temporary and stress-induced? Or is it reaaonable to revise the theory of the stroke, and warrant lifetime coumadin? -dr.XXXX (phd, not md)

Answered by Dr. Benard Shehu (2 hours later)

Brief Answer:
I'm waiting for ECHO and holter results to be uploaded...

Detailed Answer:
Hi and thank you for asking!
I read your query and understood your concerns.

You shouldn't revise the stroke theory. The paradoxical stroke is a well-known finding in patients with permanent foramen ovale (PFO). The current guidelines for patients with PFO are to close the foramen (as you already did) and to take warfarin on a daily basis.

The permanent foramen ovale as part of interatrial septal defect may be accompanied with an enlarged right atrium that may be the cause of atrial fibrillation.

Can you upload your Echo results please, so i can check it by myself? In case that there's evidenced right atrium enlargement than atrial fibrillation isn't temporary or stress induced.

Moreover can you upload the holter monitoring results because I would like to judge by myself those results.

I' m waiting for ECHO and Holter results to be uploaded.
Wish you health!
Dr. Shehu

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Benard Shehu (1 hour later)

Thanks! I'll scan the holter results and upload them Tuesday when I'm at the office. You just need the one-page analysis summary? The post pfo-closure echo is scheduled for the 10th. Do you want to see the echo from February when I had the stroke?

Answered by Dr. Benard Shehu (5 minutes later)

Brief Answer:
Following answer to your query.

Detailed Answer:
Hi back,

Yes I will wait for the one page analysis summary. i would like to have also the February's echo reports.

I'm waiting for Tuesday to have all these data.
Till then wish you health!
Dr. Shehu

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Benard Shehu (48 hours later)

I uploaded the holter from last week, and echos (regular and TEE) when I was in the hospital for the stroke in February. Looking forward to your thoughts.

Answered by Dr. Benard Shehu (18 hours later)

Brief Answer:
Following advice...

Detailed Answer:
Hi back,

After reviewing the holter and Echo results I can say that your heart structure and function is normal. The only problems were intraatrial septal defect and arrhythmias.

Now that intraatrial septal defect is closed and your heart was normal you should take treatment for paroxystic atrial fibrillation.

If you were my patient I would recommend you to take warfarine and betablockers to treat arrhythmias and to prevent future cardiovascular risks.

Hope this was of help!
Wish you health!
Dr. Shehu

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Benard Shehu (6 minutes later)

Dr. Shehu, I am taking those exact medications now, but do you think the afib is temporary or permanent?

Answered by Dr. Benard Shehu (16 minutes later)

Brief Answer:
Following advice.

Detailed Answer:
Hi back,

Paroxystic atrial fibrillation in most of the cases is temporally or to be more precise it will come and go with actual treatment.

Atrial fibrillation only in a few cases may become permanent. Unfortunately the last word is said after one year. This is why it's important the treatment and regular follow up with echo and holter monitoring every sixth months.

In case that atrial fibrillation will be present on holter even after one year than most likely your atrial fibrillation has a high probability to become permanent.

Wish you health!
Dr. Shehu

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Benard Shehu (8 minutes later)

I see. That's what I suspected; that the heart may need 6 to 12 months to fully heal and adjust itself to the device implantation. In the meantime, I am doing what I can at home, exercise, yoga, meditation, healthy diet, and reduced workload to reduce stress.

Thank you for your feedback and for taking the time to review my records!

Answered by Dr. Benard Shehu (6 minutes later)

Brief Answer:
You are most welcome!

Detailed Answer:
Hi back,
You are most welcome!

If you are satisfied with my answer please close this query and rate it to maximum.

If you have more questions in the future dont hesitate to contact me directly on the following link:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=66762

Wish you health!
Dr. Shehu

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar