Patent Foramen Ovale Clinical Presentation

Updated: Nov 20, 2016
  • Author: Sandy N Shah, DO, MBA, FACC, FACP, FACOI; Chief Editor: Yasmine Subhi Ali, MD, FACC, FACP, MSCI  more...
  • Print
Presentation

History and Physical Examination

Most patients with isolated patent foramen ovale (PFO) are asymptomatic. Patients may have a history of stroke or transient ischemic event of undefined etiology. [11]

Some present with migraine or migrainelike symptoms. Whether symptoms are due to transient ischemic attacks or paradoxical embolism is not clear.

Neurologic decompression sickness is seen with PFO in a small percent of scuba divers. Risk of nitrogen gas embolism across PFO increases in scuba divers. In unexperienced divers, PFO can worsen hypoxemia at great depth leading to death.

Other less common clinical manifestations of PFO include the following:

  • Acute myocardial infarction [1, 2]
  • Systemic embolism, such as renal infarction [3]
  • Fat embolism [4]
  • Right atrial tumors increase right atrial pressure, which can cause paradoxical embolism [2]
  • Left-sided valve disease in carcinoid syndrome [5]

No abnormal cardiac clinical findings are associated with isolated PFO.