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Forum Name: Congenital Heart Disease in Adults

Question: ASD PFO Afib


 John25 - Thu Feb 03, 2005 12:27 pm

Hello Dr.

5 '7 130 lb male
i have had irregular beats and sortness of breath with acitvity, so i went to a doc he did echo and said i had a small asd (which needs closing) with Lt to RT shunting and a bubble study which showed bad RT to Lt shunting. To confirm they had me do a TEE which showed a large mobile PFO with bi directional shunting, i was told i have slight rt heart enlargement, and my dr hears a faint sistoic murmur. i got 3 other opionions and all agree the tee shows PFO. but two said they can see a part of the TEE that suggests a small to mid ASD inadditon to the PFO. But they said it is not clear and i would need another echo focusing on that area. Both said they are sure a better study would show the asd based on the Lt to Rt flow they see.I also had an event monitor and they found PVC, PAC, PJC, SVT and A fib (A Fib only comes when i do physical activity like run or lift weights it may come during the running or several hours later). two doctors said they think the afib is related to the hole because it comes with exersice which may change the pressure in the heart and the size of the atriam and affect the electrical stuff inside it. The other two said not related.

1. does faint sistoic murmur heard mean i have asd also or can that be caused by PFO
2. can PFO cause slight rt heart enlargement or is that only caused by ASD
3. are the irregular beats a separate problem or related to the PFO/ ASD
4. how can i have an echo and tee and still need another echo per those two other Congenital heart desease Doctors. Is it possible that no one other than Congenital heart doctors not know how to perform good echos to look for ASD's.
5. I saw an electrical guy for the irrgular beats and he looked at the monitor results for a few seconds and said try troprol xl and if that doesnt work try another drug that could cause more irregular beats and go from there...what is the standard process for trying to solve irregular beats...should they look more at the monitor results or do more test..before they just say take this drug
6. Not sure what my next step should be...should i close the hole and hope it stops the afib. should i take the beta blockers and hope it stops the afib which only occurs when i run or should i go get yet another echo to see if i have an asd also?

thanks so much!!!
 Dr. Yasser Mokhtar - Tue Feb 08, 2005 3:24 am

User avatar Dear John,

To answer your questions.
1. Murmurs are sounds heard due to disturbance in blood flow. Systolic murmurs are not related to the asd/pfo perse because the disturbance in flow caused by the pfo/asd is very small to be heard, but murmurs can be heard due to increase flow across the pulmonary or tricuspid valves.
2. A pfo probably does not have significant hemodynamic effects on the heart.
3. Most probably the irregular heart beats that you have are related to the asd/pfo.
4. Transthoracic echos are usually done by echo techs and interpreted by cardiologist. On the other hand, tee is done by the cardiologists themselves. There are experienced echocardiographers and more experienced echocardiographers, sometimes, what one can find is not going to be the same as someone else. So, if both of them recommend having a tee, i would suggest that you think about having one done. However, they both said that most probably, according to other findings on the tee, they suspect that you have an asd, so why repeat it, i will leave you to discuss this with your doctors.
5. The best way to treat arrhythmias is to try and find a cause for it, if a cause can be found, then treat the cause and hopefully the arrhythmias will go away. If not, then depending on the type of arrhythmias, treatment is given accordingly using certain medications. Each doctor sees what is best for each patient and then prescribes the medicine he/she thinks is going to take care of this patient's particular problem. If this drug does not work (happens all the time), then patient is switched to another medication and so forth.
6. Personally, i think that since you are becoming symptomatic, the best way to go is to close this asd sooner rather than later, because eventually, it will need to be closed.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.
 John25 - Tue Feb 08, 2005 7:15 pm

thank you !!!!

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