I'm a 55 year old masters swimmer who's been competing and training for over 30 years. I had a stroke after an early morning swim 15 years ago, with an extensive workup subsequently revealing nothing but a patent foramen ovale--a common and usually inconsequential atrial septal heart defect. Since that time, I've been on Coumadin anticoagulation and haven't had any more strokes. However, I have had transient spells of confusion after workouts, that I had either ignored or ascribed to hypoglycemia, as they resolved quickly, usually after eating. My latest episode lasted longer, and my wife was there to witness it, so I ended up in the hospital and had a bunch of tests (CT, MRI, Cardiac Echo, EEG). Now my doctors think these have been TIA's, and that I may need a surgical closure of the atrial septal defect. I was wondering if any other masters swimmers have experienced this, as the Valsalva maneuver that one performs while swimming (like the breakout after a turn) reproduces the breath-holding, then sudden relaxation and inhalation that they asked me to perform during the echocardiogram, in order to bring out the abnormal blood flow through the patent foramen ovale. I felt just like I do during a workout when I was having the Echo. I'll bet this is something that isn't unique to me. Has anyone else had similar episodes?
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Kevin, after doing a little more reading, I want to put a slightly different emphasis on my earlier post.
First, it seems that management of a PFO requires a fair amount of individual judgement. Not all PFO's are the same. As you probably are aware, they are very common, yet in fact adverse events associated with them aren't. So its hard to generalize.
Second, you may be the exception in that it sounds you have a clear indication for warfarin, as most experts advise aspirin as an anti-platelet agent instead. Don't take this as a question of your treatment; you're just different than a lot of folks with PFO's.
The issue of a estimating benefit of procedures to close the PFO is very tricky. Our institution does the procedure but only in carefully selected cases. The devices approved are safe and do what they are designed for, but so it seems that they don't eliminate stroke risk; you can have small clots that form from many sites and surfaces. I think you would need aspirin even if you had a closure.
Sorry to muddy the water, but this is what happens often in medicine; the evidence doesn't always point to a clear answer, and judgement is required based on the particulars of your situation and the best available information.
Good luck!
Kevin, after doing a little more reading, I want to put a slightly different emphasis on my earlier post.
First, it seems that management of a PFO requires a fair amount of individual judgement. Not all PFO's are the same. As you probably are aware, they are very common, yet in fact adverse events associated with them aren't. So its hard to generalize.
Second, you may be the exception in that it sounds you have a clear indication for warfarin, as most experts advise aspirin as an anti-platelet agent instead. Don't take this as a question of your treatment; you're just different than a lot of folks with PFO's.
The issue of a estimating benefit of procedures to close the PFO is very tricky. Our institution does the procedure but only in carefully selected cases. The devices approved are safe and do what they are designed for, but so it seems that they don't eliminate stroke risk; you can have small clots that form from many sites and surfaces. I think you would need aspirin even if you had a closure.
Sorry to muddy the water, but this is what happens often in medicine; the evidence doesn't always point to a clear answer, and judgement is required based on the particulars of your situation and the best available information.
Good luck!
