Intracardiac shunting across a patent foramen ovale may exacerbate hypoxemia in high-altitude pulmonary edema

Article Abstract:

On rapidly ascending to high altitudes, approximately one percent of people suffer severe symptoms, such as extremely low blood oxygen levels, pulmonary hypertension (elevated pressures in the circulation of the lungs), and pulmonary edema, an often life-threatening collection of fluid in the lungs. One physical abnormality that might account for this phenomenon is the presence of a patent foramen ovale, an opening between the right and left sides of the heart that usually closes at birth, but can be patent (remain open) in 10 to 30 percent of people. A study was conducted on Mount McKinley to test this theory. A 42-year-old woman who developed severe high altitude symptoms was evacuated to sea level. She climbed again much more slowly, taking 12 days to achieve the same altitude. Upon arrival at the summit, she was tested to assess her blood oxygen level, which was found to be abnormally low, and her pulmonary pressures, which were abnormally high. She later had an echocardiogram which showed shunting of blood from the right to the left side, which is consistent with a patent foramen ovale. Similar echocardiogram results were found in several other patients who had altitude sickness, and two who did not. A patent foramen ovale is a plausible contributor to high altitude sickness. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Causes of, Altitude, Influence of, Mountain sickness, Altitude sickness

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Shadows on the cave wall: the role of transesophageal echocardiography in atrial fibrillation

Article Abstract:

Transesophageal echocardiography (TEE) may be very useful in detecting blood clots in the left atrium of the heart and in predicting the outcome of heart patients with blood clots. The wisdom of changing the treatment of heart patients at risk for stroke or heart attack based on TEE results may need to be proven in scientific studies. TEE provides information about the condition of the back of the heart, an area that doctors have found difficult to diagnose noninvasively. A study published in 1995 showed that TEE predicted the surgical finding of blood clots in the left atrium. The use of TEE to detect blood clots may aid the treatment of heart patients by cardioversion, or restoring the heart to its normal rhythm by electrical shock.

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Serpentine thrombus traversing the foramen ovale: paradoxical embolism shown by transesophageal echocardiography

Article Abstract:

Doctors identified a paradoxical embolism using transesophageal echocardiography in a morbidly obese 48-year-old man after failing to identify it with two other imaging techniques, computed tomography and transthoracic echocardiography. Paradoxical embolisms are masses that pass through abnormal openings between the right and left sides of the heart and have the potential to travel throughout the body. The technique allowed doctors to visualize this patient's embolism in both sides of the heart and as it passed through the abnormal openings. Autopsy results showed evidence of a heart attack two to three weeks before death.

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