Does hole in heart raise risk of heart attack?

Q. I am 38 years old. About three years ago, I suffered from vertigo and was hospitalised for observation for one night. I was then diagnosed to have an 8mm patent foramen ovale and an aortic root of 3.5cm. I am an active golfer weighing 75kg. My height is 1.78m.

My doctor encouraged me to do a check-up every year. I have tried to stay healthy by eating well. I have managed to keep my cholesterol level within the normal range.

I also gave up smoking last year when my baby was born.

During a recent annual check-up, my doctor advised me to rush to the hospital immediately should I experience any chest pain.

This has caused me some concern.

Are there any preventive measures, exercises or precautions that can help to strengthen my heart? Does this mean I am prone to heart attacks?

Patients who have cardiac risk factors, such as a blockage in one of the arteries supplying the heart, are at higher risk of a heart attack... Cardiac risk factors include smoking; a family history of heart disease, high blood pressure, high cholesterol, diabetes mellitus or elevated blood sugar; inactivity; being overweight; and in women, being in their menopause. 

A. It is important to know what is causing your vertigo or dizziness.

If the dizziness is secondary to a problem in the inner ear, which regulates balance, or is due to low blood pressure, then a patent foramen ovale, or a hole in the heart which did not close properly after birth, is not implicated.

If the dizziness is due to a stroke or a transient ischaemic attack (temporary loss of blood flow to the brain which does not cause any damage), then a hole in the heart could have played a role.

In theory, when you get a blood clot in your leg (deep venous thrombosis), the blood clot could travel from the right side of the heart to the left side through the hole in the heart, causing a stroke or a transient ischaemic attack.

If that is proven, a potential therapy could be to close the hole in the heart with a special disc using a catheter-based method.

But there is no overwhelming evidence that this is better than taking aspirin. This should be assessed on a case-by-case basis.

Other causes of stroke should be ruled out, such as blockages in the arteries to the brain and an irregular heart beat (atrial fibrillation).

An aortic root size of 35mm is still within the normal range. There is no correlation between having a hole in the heart and being at risk for a heart attack.

Patients who have cardiac risk factors, such as a blockage in one of the arteries supplying the heart, are at higher risk of a heart attack.

The more cardiac risk factors you have, the higher the risk of getting a heart attack or blockage.

Cardiac risk factors include smoking; a family history of heart disease, high blood pressure, high cholesterol, diabetes mellitus or elevated blood sugar; inactivity; being overweight; and in women, being in their menopause.

Your most important risk factor is that you were a smoker.

Generally, it is true that you should rush to the hospital if you experience chest pain.

You should ask your doctor if he said that as a general statement or specifically to you because he considers you to be at high risk for a heart attack.

If you were a heavy smoker, have a strong family history of heart disease, have high cholesterol and elevated blood sugar or diabetes, you are in the high- risk group.

As cardiologists, we can check for blocked arteries by doing a number of tests, such as the treadmill test or getting the calcium score in a computed tomography or CT scan.

You can do your part to control your risk of heart disease by taking preventive measures. They include exercising regularly, having a healthy diet and maintaining your weight or, if you are overweight, losing weight.

In addition, keep your blood pressure, cholesterol and blood sugar in check, with or without medication.

Dr Lim Tai Tian
Cardiologist at Mount Elizabeth Hospital

A version of this article appeared in the print edition of The Straits Times on September 22, 2015, with the headline 'Does hole in heart raise risk of heart attack?'. Print Edition | Subscribe