"Lack of heart" is a word that is not unfamiliar in daily life, and now it mostly refers to doing things without seeing it, not being smooth at all, and having low emotional intelligence. So is there a real "lack of heart" from the physiological aspect? In fact, we human beings have been "lacking the heart eye" since childhood, but they have just closed it in the later development process!
"Missing heart eye" is explained in medical terms as foramen ovale, which is the two septums between the atria during embryonic development, and gradually grow relative to each other to separate the two atrium, but it is not completely adherent and fused, leaving a small fissure called foramen ovale.
Although this "lack of heart" actually refers to the heart, many of the symptoms are manifested through the "head" symptoms. For example, have you ever had a migraine and have done a lot of tests that didn't find a problem? Do you have people around you who do not have risk factors such as high blood pressure, high blood lipids, and high blood sugar, but have frequent cerebral infarctions? ...... In fact, some patients with migraine and cerebral infarction are because there is a small channel in the heart called the foramen ovale that is not closed!
50-year-old Master Zhang is a migrant worker, 178cm tall and weighs about 80kg, because of high blood pressure, Master Zhang usually does not smoke or drink, and regularly takes oral antihypertensive drugs, and his blood pressure has been very stable. Recently, when working with the workers, Master Zhang's eyes suddenly straightened, and then the right upper limb was flexed and raised, and the whole body was rotated to the left, and then his face turned blue, his teeth were closed, and his mouth was foaming at the mouth, although after a few minutes of emergency rescue by the workers, Master Zhang's consciousness was restored, and for the sake of insurance, the workers sent him to the Chengyang District People's Hospital of Qingdao City. The neurologists who received the patient found multiple softened lesions in the brain on cranial CT scan, and the cranial MR showed the coexistence of new and old cerebral infarction lesions in the brain, and the large intracranial vessels were intact, and the diagnosis of cerebral infarction-induced symptomatic epilepsy was made. Admitted to hospital for further diagnosis and treatment.
So what are the causes of cerebral infarction? Sun Hongguo, deputy chief physician of the Department of Neurology, believes that although the patient has had hypertension for many years, it has been well controlled, and there are no other risk factors for cerebrovascular disease in the inpatient examination, nor has any bad lifestyle habits, so it is proposed to improve the TCD foaming test, that is, to rule out the problem of whether it is a cardiac foramen ovale through contrast-enhanced transcranial Doppler ultrasound.
After examination, Master Zhang's foaming test was positive, and a large number of emboli could be seen, indicating that the cardiac right-to-left shunt was positive.
The foramen ovale is a small hole in the diaphragm of the left and right atria of the human heart, through which the blood of the left and right atria communicates during the fetal period, and it is a vital passage necessary for fetal development. After the fetus is born, the foramen ovale generally closes within one year of age, and if it is not closed over three years of age, it is called patent foramen ovale (PFO). In adults, 20%~25% of the foramen ovale is not completely closed.
What is the relationship between patent foramen ovale in the heart and cerebral infarction and migraine?
If the foramen ovale is not closed, when the pressure in the right atrium increases (such as coughing, sneezing, holding breath, etc.), the unclosed foramen ovale will open, and these substances will not be filtered through the pulmonary circulation, but directly enter the systemic circulation through the foramen ovale of the heart to reach the brain, thus causing cerebral infarction, migraine and other diseases.
How can I find a patent foramen ovale?
In addition to right heart catheterization (invasive testing) and echocardiography (the gold standard for diagnosing patent foramen ovale), the TCD foaming test is also an effective screening method. TCD foaming test, also known as contrast-enhanced transcranial Doppler ultrasound, uses normal saline and blood to produce microbubbles through repeated aspiration, when the microbubbles enter the human body through the vein, the subject cooperates with the Valsalva action (deep inhalation and then holds the breath, and then exhale forcefully), and at the same time uses transcranial Doppler ultrasound (TCD) to observe whether the microbubbles enter the intracranial cerebral artery. A positive foaming test indicates that microbubbles of the venous system can enter the intracranial cerebral artery, while a negative test indicates that the intracranial cerebral artery has not entered. Patent foramen ovale (PFO) is the result of 95% of positive TCD foaming tests, and other rare causes such as atrial septal defect, ventricular septal defect, and pulmonary arteriovenous malformation.
Figure 1: Communication
Figure 2 Making microbubbles
Fig. 3 Resting position examination
Figure IV: Valsalva post-maneuver checked
Who needs to do TCD foaming test?
(1) Some young people with unknown causes of stroke, aged < 55 years old, have no risk factors such as hypertension, diabetes, and hyperlipidemia
(2) Patients with transient ischemic attack, cerebral infarction with or without symptoms, and carotid arrhythmia with no obvious disease of carotid artery and not easy to form embolism;
(3) Migraine and episodic syncope;
(4) Decompression sickness, and decompression sickness to be excluded from the physical examination of divers or astronauts;
(5) Follow-up after patent foramen ovale closure.
Who can't do TCD foaming test?
1) Patients with severe heart, liver, kidney, lung damage, malignant tumors, hematologic, and autoimmune diseases;
2) Patients who are unable to cooperate with Valsalva examination due to impairments such as consciousness and cognition
3) Patients with carotid artery stenosis or congenital intracranial vertebral artery dysplasia, and patients without temporal window who cannot find the unilateral middle cerebral artery
4) Pregnant and lactating women
TCD foaming test is a non-invasive test, and it is also the only technical method that has been confirmed to be able to observe the microemboli signal in the cerebral circulation in real time. Simple, sensitive, safe, non-invasive, and easily reproducible, it has been widely used for the screening of patent foramen ovale (PFO). At present, the TCD examination room of the Department of Neurology of Chengyang District People's Hospital of Qingdao City has carried out a number of foaming tests, and screened 2 positive cases of foaming tests. Patients with symptoms can consult a doctor.
How to make an appointment
1. Outpatient: Go to the neurology outpatient department to make an appointment, TCD room appointment, Monday to Saturday all day
2. Inpatients: The bed doctor should contact Li Qiuju from the Department of Neurology or Gao Jian from the TCD Department
Check the location
TCD examination room of neurology on the second floor of the outpatient building of Chengyang District People's Hospital of Qingdao City
Contributed by: Qiuju Li, Department of Neurology
Review: Pan Wenyong, Yang Yanfang