Should I have a PFO test?

[CotoChris]

I'm in the process of having an annual check up. One of the tests last thursday was for my heart, actually two tests: A scan of my heart and an examination under excersise. As the doctor was doing the scan I mentioned I was a diver and PFO is an important factor to consider. From the scan he thought I had no reason to worry however because I was a diver I had a valid reason to have one. I just have my GP to fill out a form, the cost wouldn't be more than €20-30.

The scan results I receive tommorrow but initially the doctor said I my heart looked perfectly OK. I havn't had the bends or reason to believe to have a PFO, It's just a case I have an opportunity to have one. Should I take it or just not worry about it?

What is like having one? I gather they place a sensor sown your throat, can't imagine it being pleasant at all.

[frosty the snowman]

Mine was just done externally very much like a pregnancy ultrasound scan. Things have probably changed a wee bit since 1989 (!) and cardiology is not my thing at all! The only scary bit was having a small amount of air injected Iv and then doing a valsalva to try to demonstrate the PFO. I didn't have one. And I've never been pregnant either I should add! I really see no reason to have a scan unless you've been bent. Remember 25% of the population (including divers) have some sort of PFO...

[Steve S]

Chris I found this informative DAN Divers Alert Network : Patent Foramen Ovale: Is It Important to Divers?

Safe diving,
Steve

[chrisch]

Chris I doubt, even in Portugal, that the correct test is that cheap. (If it is there will be lots of people taking it there instead of in the UK).

A standard ECG might be about that price but will not diagnose the PFO. The correct test is a transesophageal echocardiogram. Pretty specialist stuff.
TEE

You have gas bubbles injected into you so they can be "seen" shunting or not shunting. They are a PITA to get on the NHS (missus had one) and it would appear that only a handful of UK docs understand the first thing about them.

Uk price is several hundred pounds.

If you do find a place that does it for 30 euro let everyone know!! And make sure you get yours for free as commission!!

Chris

[Janos]

There was a doctor in Bristol who would do them for £150-ish. Have a search on the BSAC forums.

Janos

[CotoChris]

Sorry, should have mentioned that it's private, the €30 is the 'nominal' fee. Going to town this afternoon to pick up the results for the ultrasound scan.

[Helen F H]

Having been through this, and all the wrong tests i hope this is of some help.

A PFO test can be one of several things. First off a normal echocardiogram will not show it. You need contrast ie bubbles to show if blood is passing from one side of the heart to the other. Putting bubbles into the blood is not without risk as they have the potential to travel to the brain, ripping your oesphagus etc etc. To view these bubbles you can have a transoesophageal echo, very very unpleasant (imagine swallowing a garden hose and feeling it move around in your food pipe for 30 minutes while you retch every 30 seconds). This test needs to be understood by the doctor doing it, otherwise it is a waste of time. The test which finally settled the score for me was not a TOE but an echo done by Pete Wilmshurst in Shrewsbury. This was done with contrast and was not as unpleasant as the TOE by a long way but still involved the risk with the bubbles migrating.

Private the test will set you back several hundred pounds in the UK, NHS waiting times vary, i waited 8 months.

If you have had any reason to think you have a PFO, or if the consultant really knows his shit, then go ahead.

[Fee]

Just a few points....
As I have posted before, htere is a common misconception that only a handful of "elite" doctors understand about PFO or echo. All cardiology consultants are trained to interpret echocardiograms, and certainly recently have to perform TOE as part of their training, although many of them will not continue to perform TOE. If your cardiologist does a TOE, it is because he does them regularly; if not they will refer you to someone who does. The issue is not so much finding an abnormality (I bet even PW occasionally misses one); the issue is in interpreting how it affects you. If you have a PFO or other ASD, the cardiologist doing the TOE can advise you of your surface risks (eg cardiac failure, paradoxical emboli from DVT) however unless they have an interest or qualification in diving medicine they cannot advise you on your diving risk.
If your heart is structurally normal, then the bubble test is low risk, as your lungs will filter out the bubbles. You actually need a pretty large amount of air in your venous circulation to cause air embolus (I have been quoted 50ml, but I don't know if that's true. Still it's quite fun after putting in a CVP line (that sits just outside the entrance to the right side of the heart) to wind the nurses up by holding up a 20ml syringe of air and saying "shall we see if 20 ml is enough?" (warning - only do this with nurses you know well otherwise complaints will follow)).
I don't understand how intravenous bubbles could rupture the oesophagus. I assume that Helen is talking about the risk of oesophagus perforation she was consented for prior to TOE- the risk of perforation is from the endoscope, not the bubbles.

[Paul-W]

I work with Cardiologists, and when I asked about this test they said unless I had migrane or had been bent, it was not really worth it unless it was for "peace of mind".
Just thought that might help the debate.