Stroke survivor links heart hole to hidden risk of future strokes

March last year, 40-year-old Aimee Rogers collapsed at 6:25 a.m. at home in Harrogate with the entire left side of her body paralyzed. A fit and healthy mother of two, with normal cholesterol, blood pressure and BMI, she did not fit the typical stroke picture. After an ambulance rushed her 22 miles to York Hospital, a CT scan ruled out brain bleeding, and medics proceeded with clot-dissolving treatment within the four-and-a-half-hour window. About 24 hours later, an MRI confirmed a clot on the brain's right side. She was discharged the following day with anti-clotting medicines and told she faced a higher risk of a second stroke in the next three months while doctors hunted for the underlying cause.

Ten days after the stroke, she experienced a shorter event, a transient ischemic attack, with similar symptoms that resolved within about three hours. The episode left her anxious, fatigued and sensitive to loud environments. She stepped back from a high-pressure job and began rethinking how to spend her time, eventually retraining in yoga and exercise referral and now works with Active Against Cancer to help patients with movement and breathing techniques.

To determine the cause, doctors performed a 72-hour heart monitor to check for atrial fibrillation, but the rhythm remained normal. The stroke consultant suspected a patent foramen ovale, or PFO, a small opening between the heart's upper chambers that normally closes after birth. A bubble-contrast echocardiogram showed a large, pathological PFO about half an inch wide with a strong shunt, confirming that a clot could pass from the right to the left side of the heart and reach the brain. In the United Kingdom, about a quarter of adults have a PFO, often without symptoms, according to the British Heart Foundation. The tissue flap that normally seals the hole in most people is kept shut by pressure inside the heart, but in some individuals the opening remains.

Not all PFOs require treatment. Treatment decisions depend on prior stroke or high clot risk. For Aimee’s case, the presence of a confirmed stroke and a sizeable hole with a strong shunt made closure a consideration. The NHS wait list for the standard surgical route was about three years in her area, so she joined a trial that used local anesthesia so patients could be treated sooner. In August last year the procedure was performed in Leeds Royal Infirmary’s operating theatre normally used for children, using an implant that resembles a closed umbrella to seal the hole. The device is designed to allow heart tissue to grow over it and seal the opening permanently. There was a small risk of stroke during the procedure, and the main concern was bleeding; the patient had to lie still for about two hours afterward to prevent arterial bleeding. She was discharged home the same day and instructed not to lift heavy objects for two weeks.

One year after the stroke, Aimee reports ongoing fatigue and concentration challenges, with recovery timelines sometimes extending for years. The experience prompted a re-evaluation of life priorities with her husband. The family decided to value time together and reduce discretionary spending, focusing on parental presence. Aimee retrained and now works with a charity to teach yoga and exercise to patients of all ages as a form of healing and recovery.

Health experts say PFOs are common but most people will never have a stroke linked to the opening. The presence and size of the hole, the strength of the shunt and the likelihood of forming clots all influence risk. PFOs are not routinely screened because they typically do not affect heart function. A bubble-contrast echocardiogram is a specialized test that can reveal bubbles crossing from the right to the left side of the heart, indicating a PFO. When patients have had a stroke or TIA with no clear cause, doctors may discuss closure and prevention options.