Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Ways To Rule Out A Patent Foramen Ovale In The Heart
Question: Could someone have a pfo and it not show up on a regular echo but show on a TEE?
Could certain movements like bending or different positions cause it to open and cause symptoms?
Would laying flat make it better or worse?
I should add that I had an echo that said I had a mild left to right shunt but then another echo that did not show it and a bubble test that was normal.
Could certain movements like bending or different positions cause it to open and cause symptoms?
Would laying flat make it better or worse?
I should add that I had an echo that said I had a mild left to right shunt but then another echo that did not show it and a bubble test that was normal.
Brief Answer:
Please see detailed report.
Detailed Answer:
Dear Madam
1. A PFO is a communication between left and right atrium during foetal life (when we are in mother's uterus). It helps in directing blood from right atrium to left atrium. It closes spontaneously after the birth after a variable period. However, it persists as such in one-third of individuals. By definition, the blood travels from right side to left side only. Uncommon pathological conditions may cause the blood to travel from left to right side.
2. Yes, It is very much possible that a PFO is not seen on transthoracic ECHO but is seen on transesophageal ECHO (TEE).
3. Any maneuver which increases pressure in right atrium, may be transiently, can result in flowing of blood through PFO from right to left. Commonly when a baby cries, the shunt may be visible. Theoretically lying down should not make it worse as blood flow to right side of heart decreases in lying down.Similarly, conditions or maneuvers which decreases pressure in left atrium may result in flow through PFO.
4. It may be a possibility that some one may miss PFO or a small atrial septal defect on one ECHO and other person may pick it. However absence on TEE and bubble test makes it less likely to be there.
Hope this helps. Feel free to discuss further.
Sincerely
Sukhvinder
Please see detailed report.
Detailed Answer:
Dear Madam
1. A PFO is a communication between left and right atrium during foetal life (when we are in mother's uterus). It helps in directing blood from right atrium to left atrium. It closes spontaneously after the birth after a variable period. However, it persists as such in one-third of individuals. By definition, the blood travels from right side to left side only. Uncommon pathological conditions may cause the blood to travel from left to right side.
2. Yes, It is very much possible that a PFO is not seen on transthoracic ECHO but is seen on transesophageal ECHO (TEE).
3. Any maneuver which increases pressure in right atrium, may be transiently, can result in flowing of blood through PFO from right to left. Commonly when a baby cries, the shunt may be visible. Theoretically lying down should not make it worse as blood flow to right side of heart decreases in lying down.Similarly, conditions or maneuvers which decreases pressure in left atrium may result in flow through PFO.
4. It may be a possibility that some one may miss PFO or a small atrial septal defect on one ECHO and other person may pick it. However absence on TEE and bubble test makes it less likely to be there.
Hope this helps. Feel free to discuss further.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Remy Koshy
Well I have a lot of strange symptoms but the worst is being short of breath. I become very short of breath when walking up inclines or stairs. When I bend, lift things or even sometimes raising my arms above my head I get short of breath and have to take in these deep breaths. When I lay flat I feel so much better! Sometimes it happens at random. I have listened to my heart at times it happened. For instance my heart will be beating really fast, then when I lay down, its like my heart pauses and then resumes a normal beat. It will be 120s then I lay down, it pauses and will be beating in the 70s. Its like when I lay down it resets itself. I don't know why I have to take in these deep breaths. My oxygen levels stay normal. Its very frustrating. And by the way, I have seen a psychiatrist multiple times and they said its not psych related.
Brief Answer:
please see details.
Detailed Answer:
Dear Madam
1. An uncomplicated PFO alone will not cause breathlessness. Breathlessness induced by mere change in posture is not related to PFO. If there is any other abonrmality on ECHO? Normal oxygen levels again speak against cardiac cause for breathlessness.
2. The best way to know the rhythm disorder (which you feel as fast and slow heart rate) is to get an ECG at that particular time. If it is not feasible to have an ECG at that time, one can have a Holter monitoring done if the symptoms occur at least once in a day. If symptoms are less frequent than that, an external or internal loop recorder is usually required depending upon the frequency. However, without knownig the exact rhythm, it is not feasible to comment anything about the feeling of slow/ fast heart rate.
3. Generally speaking, rhythm disorder of heart have certain RED FLAG SIGNS. These include loss of consciousness (may be transient), blackout, unexplained fall & severe dizziness. In presence of any of these, one must see the doctor on priority.
Hope this helps in some way. Please upload your reports including ECHO report for further deliberation.
Sincerely
Sukhvinder
please see details.
Detailed Answer:
Dear Madam
1. An uncomplicated PFO alone will not cause breathlessness. Breathlessness induced by mere change in posture is not related to PFO. If there is any other abonrmality on ECHO? Normal oxygen levels again speak against cardiac cause for breathlessness.
2. The best way to know the rhythm disorder (which you feel as fast and slow heart rate) is to get an ECG at that particular time. If it is not feasible to have an ECG at that time, one can have a Holter monitoring done if the symptoms occur at least once in a day. If symptoms are less frequent than that, an external or internal loop recorder is usually required depending upon the frequency. However, without knownig the exact rhythm, it is not feasible to comment anything about the feeling of slow/ fast heart rate.
3. Generally speaking, rhythm disorder of heart have certain RED FLAG SIGNS. These include loss of consciousness (may be transient), blackout, unexplained fall & severe dizziness. In presence of any of these, one must see the doctor on priority.
Hope this helps in some way. Please upload your reports including ECHO report for further deliberation.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Prasad
1.) What could cause my heart rate to drop so quickly when lying flat then? My doctor also said that I have an exaggerated HR response when going up stairs.
2.)Does taking deep breaths effect vascular flow through the lungs or heart?
Below is the echo that said minimal left to right shunt
BP: 118 / 82 HR: 70 Rhythm: Sinus
Technical Quality:Good
MEASUREMENTS (Male / Female) Normal Values
2D ECHO
LV Diastolic Diameter PLA 4.2 cm 3.7 - 5.6 cm Aortic Root Diameter 2.8 cm 2.0 - 3.7 cm
LV Systolic Diameter PLAX 2.8 cm 2.0 - 4.0 cm LA Systolic Diameter LX 3.6 cm 1.9 - 4.0 cm
LV Fractional Shortening 33.3 % 28 - 46 % LV Diastolic Volume MOD B 84.0 cm³ 67 - 155 / 56 - 104 cm³
LVPW Diastolic Thickness 0.9 cm 0.6 - 1.1 cm LV Ejection Fraction MOD 63.1 % >= 55 %
IVS Diastolic Thickness 0.9 cm 0.6 - 1.1 cm LV Stroke Volume MOD BP 53.0 cm³
RV Internal Dimension 2.1 cm 0.7 - 2.6 cm
DOPPLER
AV Peak Velocity 1.3 m/s MV Deceleration Time 238.0 ms
AV Peak Gradient 7.0 mmHg LV E' Lateral Velocity 17.3 cm/s
Mitral E Point Velocity 0.8 m/s Mitral E to LV E' Lateral 4.8
Mitral A Point Velocity 0.6 m/s TR Peak Velocity 1.9 m/s
Mitral E to A Ratio 1.3 TR Peak Gradient 14.4 mmHg
INTERPRETATIONS
Left Ventricle Normal left ventricular size and wall thickness with preserved systolic function. Ejection fraction 63%. No
wall motion abnormalities. Normal diastolic filling pattern.
Right Ventricle Normal right ventricular size and systolic function.
Right Atrium Normal size right atrium.
Interatrial Septum Cannot rule out PFO with minimal left-to-right shunt by color Doppler.
Left Atrium Normal size left atrium.
Mitral Valve Structurally normal mitral valve with trace mitral regurgitation.
Aortic Valve Tricuspid aortic valve with no flow abnormality.
Tricuspid Valve Trace tricuspid regurgitation with normal right ventricular systolic pressure.
Pulmonic Valve Trace pulmonic regurgitation.
Pericardium No significant effusion.
Aorta Not well visualized.
Other Normal IVC size with normal respiratory collapse.
CONCLUSION
1. Normal left ventricular size with preserved systolic function. Ejection fraction 63%. No wall motion abnormalities. Normal
diastolic filling pattern.
2. Trace mitral regurgitation.
3. Tricuspid aortic valve with no flow abnormality.
4. Normal right ventricular systolic function. Trace tricuspid regurgitation with normal right ventricular systolic pressure.
5. Compared with April 16, 2015 study, there is no significant change.
2.)Does taking deep breaths effect vascular flow through the lungs or heart?
Below is the echo that said minimal left to right shunt
BP: 118 / 82 HR: 70 Rhythm: Sinus
Technical Quality:Good
MEASUREMENTS (Male / Female) Normal Values
2D ECHO
LV Diastolic Diameter PLA 4.2 cm 3.7 - 5.6 cm Aortic Root Diameter 2.8 cm 2.0 - 3.7 cm
LV Systolic Diameter PLAX 2.8 cm 2.0 - 4.0 cm LA Systolic Diameter LX 3.6 cm 1.9 - 4.0 cm
LV Fractional Shortening 33.3 % 28 - 46 % LV Diastolic Volume MOD B 84.0 cm³ 67 - 155 / 56 - 104 cm³
LVPW Diastolic Thickness 0.9 cm 0.6 - 1.1 cm LV Ejection Fraction MOD 63.1 % >= 55 %
IVS Diastolic Thickness 0.9 cm 0.6 - 1.1 cm LV Stroke Volume MOD BP 53.0 cm³
RV Internal Dimension 2.1 cm 0.7 - 2.6 cm
DOPPLER
AV Peak Velocity 1.3 m/s MV Deceleration Time 238.0 ms
AV Peak Gradient 7.0 mmHg LV E' Lateral Velocity 17.3 cm/s
Mitral E Point Velocity 0.8 m/s Mitral E to LV E' Lateral 4.8
Mitral A Point Velocity 0.6 m/s TR Peak Velocity 1.9 m/s
Mitral E to A Ratio 1.3 TR Peak Gradient 14.4 mmHg
INTERPRETATIONS
Left Ventricle Normal left ventricular size and wall thickness with preserved systolic function. Ejection fraction 63%. No
wall motion abnormalities. Normal diastolic filling pattern.
Right Ventricle Normal right ventricular size and systolic function.
Right Atrium Normal size right atrium.
Interatrial Septum Cannot rule out PFO with minimal left-to-right shunt by color Doppler.
Left Atrium Normal size left atrium.
Mitral Valve Structurally normal mitral valve with trace mitral regurgitation.
Aortic Valve Tricuspid aortic valve with no flow abnormality.
Tricuspid Valve Trace tricuspid regurgitation with normal right ventricular systolic pressure.
Pulmonic Valve Trace pulmonic regurgitation.
Pericardium No significant effusion.
Aorta Not well visualized.
Other Normal IVC size with normal respiratory collapse.
CONCLUSION
1. Normal left ventricular size with preserved systolic function. Ejection fraction 63%. No wall motion abnormalities. Normal
diastolic filling pattern.
2. Trace mitral regurgitation.
3. Tricuspid aortic valve with no flow abnormality.
4. Normal right ventricular systolic function. Trace tricuspid regurgitation with normal right ventricular systolic pressure.
5. Compared with April 16, 2015 study, there is no significant change.
Brief Answer:
please see details.
Detailed Answer:
Dear Madam
1. Our heart rate increases when we do any kind of mental or physical job. Standing from lying down in one such job. However, mostly the increase is not perceptible.In certain individuals the increase may be abnormally high (postural orthostatic tachycardia syndrome). As a corollary when we lie down, the heart rate decreases. There are specific tests which are done to ascertain if increase is exaggerated or not. So one explanation for normalization of heart rate is physiological decrease on lying down. Second theoretical explanation is the some rhythm disorder is going on which terminates on lying down. Although this is more novel than real.
2. Deep Breathing increases flow from body to heart and to lungs. Though the increment in flow is not substantial.
3. I have seen your report. It merely suspects a shunt but is not confirmatory. As I told you earlier PFO alone are not associated with breathlessness.
Sincerely
Sukhvinder
please see details.
Detailed Answer:
Dear Madam
1. Our heart rate increases when we do any kind of mental or physical job. Standing from lying down in one such job. However, mostly the increase is not perceptible.In certain individuals the increase may be abnormally high (postural orthostatic tachycardia syndrome). As a corollary when we lie down, the heart rate decreases. There are specific tests which are done to ascertain if increase is exaggerated or not. So one explanation for normalization of heart rate is physiological decrease on lying down. Second theoretical explanation is the some rhythm disorder is going on which terminates on lying down. Although this is more novel than real.
2. Deep Breathing increases flow from body to heart and to lungs. Though the increment in flow is not substantial.
3. I have seen your report. It merely suspects a shunt but is not confirmatory. As I told you earlier PFO alone are not associated with breathlessness.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
One more question. Are you able to hear a shunt when listening to the heart?
What would cause a murmur to be audible only when under exertion?
Listening to my heart at rest it sounds perfectly normal. However, after going up stairs there is an obvious murmur, and I am symptomatic at those times.
During stress tests they say I have a flat blood pressure response.
What would cause a murmur to be audible only when under exertion?
Listening to my heart at rest it sounds perfectly normal. However, after going up stairs there is an obvious murmur, and I am symptomatic at those times.
During stress tests they say I have a flat blood pressure response.
Brief Answer:
please see details.
Detailed Answer:
Dear madam
1. Yes, some of the shunts can be heard but a PFO is not heard on auscultation.
2. When we exercise the flow through all the valves increases. At that time one of our valves, pulmonary valve, may give rise to murmur despite being totally normal. It is called flow murmur.
3. A flat blood pressure response during exercise may occur with coronary artery disease, dilated cardiomyopathy, obstructive lesions and autonomic dysfunction. The echo reports rule out most of these. If TMT is overall negative with good exercise capacity and without symptoms, it also speaks against coronary artery disease. However, autonomic dysfunction is a possibility. Exaggerated heart rate response after standing may also be due to autonomic dysfunction. In such cases a neurologist consultation for evaluation of autonomic nervous system is helpful.
Hope it helps. Feel free to discuss further.
Sincerely
Sukhvinder
please see details.
Detailed Answer:
Dear madam
1. Yes, some of the shunts can be heard but a PFO is not heard on auscultation.
2. When we exercise the flow through all the valves increases. At that time one of our valves, pulmonary valve, may give rise to murmur despite being totally normal. It is called flow murmur.
3. A flat blood pressure response during exercise may occur with coronary artery disease, dilated cardiomyopathy, obstructive lesions and autonomic dysfunction. The echo reports rule out most of these. If TMT is overall negative with good exercise capacity and without symptoms, it also speaks against coronary artery disease. However, autonomic dysfunction is a possibility. Exaggerated heart rate response after standing may also be due to autonomic dysfunction. In such cases a neurologist consultation for evaluation of autonomic nervous system is helpful.
Hope it helps. Feel free to discuss further.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Remy Koshy
Any obstructive lesions would show on an echo right?
How do they test for autonomic dysfunction?
It is my understanding there is no real cause or treatment for it.
How do they test for autonomic dysfunction?
It is my understanding there is no real cause or treatment for it.
Brief Answer:
please see detailed reply.
Detailed Answer:
Dear Madam
1. Yes, An obstructive lesion will show on ECHO. It is not there in the ECHO report you detailed.
2. There are different ways to check for autonomic dysfunction. It includes a battery of test which follows a detailed history. This includes response to cold, different kind of stressers, heart rate changes with respiration etc.
3. It depends upon the underlying cause of autonomic dysfunction. There may not be cure for most of them but they can be improved /controlled by various pharamocological / non-pharmacological methods (especially meditation may help in it). However, a neurologist may throw better light on it.
Sincerely
Sukhvinder
please see detailed reply.
Detailed Answer:
Dear Madam
1. Yes, An obstructive lesion will show on ECHO. It is not there in the ECHO report you detailed.
2. There are different ways to check for autonomic dysfunction. It includes a battery of test which follows a detailed history. This includes response to cold, different kind of stressers, heart rate changes with respiration etc.
3. It depends upon the underlying cause of autonomic dysfunction. There may not be cure for most of them but they can be improved /controlled by various pharamocological / non-pharmacological methods (especially meditation may help in it). However, a neurologist may throw better light on it.
Sincerely
Sukhvinder
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
