Medical question re: the heart and blood clots

VeryCoolSpouse had a mild stroke. The doctor says a normal heart has a mechanism that prevents clots from going to the brain, and that something is wrong with VCS’s heart that allowed the clot to cause a stroke. Can someone help me understand what happened and what might be done about it?

Sorry to be vague, VeryCoolSpouse, although a wonderful person and brilliant artist, is not the world’s best reporter.

I’m assuming the doc is referring to either an “atrial septal defect” (a hole connecting the upper chambers of the heart, with a 0.4% incidence) or a so-called “patent foramen ovale” (a potential hole connecting the upper chambers, occuring in about 20% of people). In fact, a PFO by itself is probably not a risk factor for stroke. But, if associated with another abnormality (an “atrial septal aneurysm”), is.

In either case, the idea is that since there’s a connection between the two chambers on the left and right sides of the heart, it makes it possible for clots from the leg to actually go to the brain (usually, if formed, such clots must stay in the right side of the heart where they can’t go to brain, although they do go the lungs).

Make sense? Want more?

The usual caveat about Internet diagnosis aside - it sound like there are two problems here - a tendency towards clotting (which can be controlled by anticoagulant drug therapy) and the type of defect KarlGauss describes, which might not be significant except for the clot-forming tendency.

Seems the doc needs to do a better job of explanation or maybe printing off info for your husband and you to read so that you both understand treatment options.
Hope he’s feeling better.

Another heart problem that can cause strokes is atrial fibrillation, a form of arrythmia. During atrial fibrillation the blood does not completely empty from the upper chambers of the heart and can pool and clot. If you go back into normal sinus rhythm the clot can end up in the brain.

[Nitpick]Whether the atrial fibrillation reverts back to normal sinus rhythm or not is irrelevant to the risk of stroke in a fib. Patients with either have identical risks of stroke.

It used to be said that people with a fib who go back into normal sinus rhythm have a higher risk, but that just ain’t so. Presumably, the reason that the risk is the same is that people who go in and out of a fib, by definition, spend less time fibrillating so they have less time to form a clot although they do tend to “kick” it out when they go back to sinus rhythm. OTOH, chronic a fibbers, who stay in a fib, have lots of time to form a clot. So, even if they are unlikley at any moment to have it leave the heart, the net effect is the same.

Here is one reference. There are many more (and better, but I’m lazy).

OK, here’s a better (and rather readable, free, full-text reference).

Thank you KarlGauss , I’ve reached that age where a lot of what I know used to be true, but isn’t any more. It’s always good to learn something new.

I’m counting on the doc to do the right thing, I just feel more comfortable if (feel like) I have a clue. I’d go along and hear for myself what is said, but SOMEbody has to stay home with the little ones.

Having read the link provided by KarlGauss, it seems that treating the clots is a matter of anticoagulants. What about the “hole in the heart” bit. Do they slap a patch over it or what?

We’re still waiting on an appointment with the heart specialist.