Most people think of a stroke as only a brain disorder, but sometimes it’s a matter of the heart.
That’s why structural cardiologist Dr. Kimberly Atianzar and neurologists Drs. Jeffrey Switzer, Askiel Bruno and Dilip Singh have come together to create a new heart/brain clinic in the AU Health Cardiovascular Care Center.
The specialized clinic – the only one of its kind in the region – allows stroke patients who fit certain criteria to be seen by both a stroke specialist and a structural cardiologist in the same day to determine the best course of care.
Atianzar explained that in certain patients, there is a flap in the heart that should have sealed at birth but didn’t. On rare occasions, a blood clot forms elsewhere in the body and travels to the heart, through the unsealed flap and into the brain, causing a stroke.
“This is a special situation that requires some expert decisions to be made by a cardiologist and a neurologist, because this is about strokes from blood clots that start in the heart or go through the heart,” Bruno said.
About 25 percent of the population has this unsealed flap in the heart, called Paten Foramen Ovale (PFO).
Because babies in the womb do not breathe, blood can’t travel through the lungs to pick up oxygen. So in the womb, oxygenated blood from the mother’s umbilical cord passes from one side of the heart to the other through the flap, or foramen.
“When you are born and take your first breath, the pressures on your left side of your heart go up. The right side creates a low-pressure system.” Atianzar said. “By nature, the pressure should cause the flap to close, and then over time you’re supposed to build tissue so it seals.”
In about 25% of the population, this flap doesn’t seal completely. For most people, this doesn’t cause problems. There are no symptoms or conditions to worry about, and no reason to explore closing it.
But sometimes, a blood clot passes through this opening, goes to the brain and causes a stroke. And because patients who have one stroke are at a much higher risk for having another, closing that leak may be the best treatment.
“The complicated part is to decide if that leak is responsible for the stroke, which is not always the case,” Bruno said. “So that’s why two experts are better than one – a cardiologist and a neurologist.”
If closure of the PFO is needed, Atianzar will perform a transcatheter procedure under sedation, which is far less invasive than open-heart surgery that would have been required a couple of decades ago.
In some cases, the patient can even go home the same day.
Because it’s a very common condition, and most people with it don’t have symptoms, it would not be efficient to perform this procedure on everyone who has an PFO. Likewise, not everyone who has a stroke has an PFO.
“There are many reasons for having a stroke, like if your blood pressure is high, or if you have a head trauma, or you develop arrhythmia later in old age,” Atianzar said. “PFO doesn’t cause a stroke, it just serves as a pathway.”
Singh said it’s the combination of having the PFO and the stroke that is the issue at the heart of this clinic.
“That’s when it becomes an issue where you need to decide whether it needs closing or not,” he said. “We need to decide whether the stroke is actually coming because of that leak, or is there something else that’s going on that caused the stroke? This is not always straightforward to figure out.”
The clinic is held once a month at AU Health’s Cardiovascular Center.