One in four adults may have a hole in the heart linked to stroke, doctors warn

One in four adults may have a patent foramen ovale, a small opening between the upper chambers of the heart that usually closes after birth, a condition that can raise stroke risk even in people who are healthy. The presence of a PFO often goes unnoticed because it typically does not cause symptoms. A case from the United Kingdom highlights how such a hole can contribute to a stroke, the diagnostic steps that follow, and the treatment options that can reduce the risk of recurrence.

Aimee Rogers, 40, was a fit, active mother of two who ran ultramarathons and maintained a healthy BMI with normal cholesterol and blood pressure. In March of the previous year, she woke at 6:25 a.m. to make a cup of tea and collapsed. The entire left side of her body went numb and she could not speak clearly, though she remained conscious. The emergency call sent an ambulance to her home in Harrogate, and the crew rushed her 22 miles to York Hospital. A CT scan ruled out a brain bleed, and she received thrombolysis, a clot-busting drug, within the four-and-a-half-hour window that is critical for reducing disability after a stroke. A little over 24 hours later, an MRI confirmed a clot on the brain’s right side was responsible for the stroke. She began anticoagulant therapy to prevent further clots and was discharged within a day, with plans for ongoing evaluation.

Within days, Rogers experienced a transient ischemic attack, or mini-stroke, with symptoms that appeared gradually and resolved within about three hours. The episode intensified her anxiety and brought fatigue and cognitive issues, and she eventually left her job as a director in a multi-academy trust to reduce stress and focus on recovery. Doctors pursued tests to identify the underlying cause of the stroke. A 72-hour heart monitor ruled out atrial fibrillation, an irregular heartbeat that can raise stroke risk. While several standard tests were performed, doctors suspected a PFO could be the culprit behind the strokes and began more targeted investigations.

A bubble-contrast echocardiogram, an enhanced heart ultrasound that uses saline bubbles to reveal openings between chambers, confirmed the presence of a pathological PFO in Rogers. The test showed a large hole — about half an inch — with a strong shunt that allowed clots to travel from the right to the left side of the heart and on to the brain. A PFO is a normal fetal opening that usually seals after birth; when it remains open, a clot can pass through and cause a stroke. The hole’s size and the strength of the shunt help determine whether treatment is advisable. In Rogers’ case, findings indicated a high-risk PFO that required intervention.

In adults, PFOs are not routinely screened for because most people do not experience symptoms or heart problems. “PFOs usually don’t cause any symptoms or problems with how the heart functions, so they are not something that’s routinely checked for,” said Emily McGrath, a senior cardiac nurse with the British Heart Foundation. When a PFO is discovered after a stroke, however, doctors weigh the benefits and risks of closure versus medical management based on the patient’s history and the likelihood of recurrent events.

With the diagnosis in hand, Rogers faced a waiting list that was long for PFO closure, attributed in part to prioritization for patients with other risk factors or more pressing conditions. NHS guidelines and scheduling considerations meant she could be treated only when a suitable window opened. In August, she was offered a trial that used local anesthesia rather than general anesthesia, allowing the procedure to proceed sooner. The operation, performed at Leeds Royal Infirmary in an adapted setting that used a pediatric operating theater, involved placing a small umbrella-shaped implant to seal the hole. Once deployed, tissue gradually grew over the device to seal the opening permanently.

The procedure carried a small risk of stroke during the operation and a higher risk of bleeding if the wound opened. Rogers described having to lie still for about two hours afterward to avoid serious bleeding from a major artery, but she went home the same evening. Postoperative guidance advised avoiding heavy lifting for a fortnight. A year after the stroke, Rogers reports that fatigue and concentration difficulties persist, symptoms she has heard can take years to improve. Nevertheless, with the hole closed, she has gradually returned to a more normal life and reoriented her career toward helping others.

Rogers has since retrained in yoga and exercise referral and now works with Active Against Cancer, teaching movement and breathing techniques to patients. She stresses that recovery is not just physical; the case helped her and her husband, Phil, reassess their priorities. “Our children had seen their mum taken away in an ambulance,” she recalls. “I realized I didn’t need the latest car or home improvement. I could adjust my work life to spend more time with my family.”

Health professionals emphasize that a PFO can be technically corrected with a procedure to seal the opening, but not every patient with a PFO requires closure. The decision hinges on prior stroke history, the presence of other clotting risk factors, and the likelihood of recurrent events. For patients who have not had a stroke or who have a low risk of recurrence, medical management and lifestyle considerations may be appropriate.

The cases like Rogers’ underscore a broader message for health awareness: while a PFO may be common — about one in four adults in the UK — it is not routinely checked unless a patient experiences a stroke or related events. Clinicians advise patients who have experienced a stroke with an unknown cause to discuss PFO testing with their cardiologist or neurologist, particularly if standard assessments do not reveal a clear etiology. Early recognition and timely treatment can reduce the chances of recurrent events and enable patients to pursue recovery and a more balanced life.

For the public, the key takeaway is to seek urgent medical attention when stroke symptoms appear and to understand that even healthy individuals can be affected. Stroke is a medical emergency, and rapid treatment within established windows can be life-changing. In cases where a PFO is identified as a contributing factor, a range of management options exist, and decisions are best made with a multidisciplinary medical team based on the individual’s risk profile and preferences.