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What Are The First Symptoms Of Patent Foramen Ovale & How Do You Test For It?

Most patients with PFO have no signs and symptoms, however, some patients suffer from migraine and it increases the risk of stroke, transient ischemic attack, and heart attack.1, 2

PFO is often diagnosed through a specific type of medical test called an echocardiogram, an ultrasound of the heart to check blood flow across the heart valves.3

There are several tests for detecting a patent foramen ovale that includes Echocardiogram, Transesophageal echo (TEE), and Bubble study.4

What Are The First Symptoms Of Patent Foramen Ovale?

Infants with a patent foramen ovale and no other heart defects usually don’t have any signs and symptoms. However, clinical studies state that PFO patients have migraine especially migraine with aura that plays a critical role in increasing the risk of stroke, transient ischemic attack, and heart attack.

Migraine Headache– Medical theories state migraine pain occurs due to waves of activities in the brain cells. The chemical that triggers the pain is called serotonin which is an essential chemical of communication between the brain nerve cells. Normal migraine does not cause stroke however migraine with a headache to have an increased risk of stroke. Stroke and migraine both occur in the brain. The association between PFO and migraine headache has been established by studies and complete patent foramen ovale closure may be key for migraine reduction.

Stroke, Transient Ischemic Attack, And Heart Attack- PFO can sometimes result in complications and one of the most serious problems is stroke. Although patent foramen ovale is not a direct causing factor of stroke yet there is a blood leakage from the right atrium to the left. This eventually turns into a gateway for a blood clot to travel to the brain and cause a stroke.1, 2

How Do You Test For Patent Foramen Ovale?

A doctor trained in heart conditions (cardiologist) may suggest one or more of the following diagnostic procedures identify the condition.

Echocardiogram (Echo) – This is a graphic outline of the heart’s movement that uses high-frequency sound waves (ultrasound) to read the pictures of the heart. This will show how well your heart is working by checking the blood flow across the heart valves and chambers.3

Transesophageal Echo (TEE) – This is a special type of echocardiogram producing images of your heart from inside, rather than outside of your body. It is usually done when your doctor wants to examine a close picture of your heart. This is perhaps the most accurate available test for doctors to see a patent foramen ovale however, there are some possible risks with this procedure because it can cause bleeding, breathing issues, and cardiovascular problems.

Bubble Study – This is a non-invasive test to assess the flow of blood between the right atrium and left atrium through the heart.4

In addition to these tests, you may require additional tests as well if you had a stroke.

When the foramen ovale does not close at the time of birth the condition is referred to as patent foramen ovale (PFO). In most patients, the hole closes on its own a few months after birth. However, in cases where it remains open, it is more like a flap that opens under normal pressure during the blood flow.

A foramen ovale allows the blood to flow around the lungs. The fetus does not use the lungs when it is in the mother’s womb so the hole will not cause a problem however, after birth it should close. But clinical studies show that 1 in every 4 cases the foramen ovale doesn’t close after birth.


  1. “Patent Foramen Ovale.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 8 Mar. 2018, www.mayoclinic.org/diseases-conditions/patent-foramen-ovale/symptoms-causes/syc-20353487.
  2. Ellis, Mary Ellen. “Patent Foramen Ovale: Symptoms, Diagnosis, and Treatments.” Healthline, Healthline Media, 29 Sept. 2018, www.healthline.com/health/patent-foramen-ovale.
  3. “Testing for PFO.” The Society for Cardiovascular Angiography and Interventions, 14 June 2017, www.secondscount.org/tests/test-detail-2/testing-pfo.
  4. “Patent Foramen Ovale.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 8 Mar. 2018, www.mayoclinic.org/diseases-conditions/patent-foramen-ovale/diagnosis-treatment/drc-20353491.

Also Read:

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:April 7, 2021

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