Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • atrial septal aneurysm
  • congenital heart conditions
  • CVA or TIA at age <50 years
  • DVT
  • abnormal cardiac examination

Other diagnostic factors

  • decompression symptoms related to diving
  • cold sensation in limb
  • limb pain
  • SOB while upright in platypnoea-orthodeoxia syndrome

Risk factors

  • atrial septal aneurysm
  • congenital heart conditions
  • FHx of migraine
  • migraine
  • FHx of PFO
  • obstructive sleep apnoea

Diagnostic investigations

1st investigations to order

  • transthoracic echo with colour Doppler and contrast injection
  • trans-oesophageal echo with colour Doppler and contrast injection
Full details

Investigations to consider

  • intracardiac echo
  • ultrasound lower extremity
  • MRI lower extremity
  • tilt-table trans-oesophageal echo
Full details

Emerging tests

  • transcranial Doppler
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Kul Aggarwal

Professor of Clinical Medicine

University of Missouri

Columbia

MO

Disclosures

KA declares that he has no competing interests.

Vibhuti Singh

Clinical Assistant Professor

University of South Florida College of Medicine

Director

Division of Cardiology

Bayfront Medical Center

St. Petersburg

FL

Disclosures

VS declares that he has no competing interests.

Peer reviewers VIEW ALL

Professor of Medicine

Director Heart Station and Echocardiography Laboratories

University of Alabama at Birmingham

Birmingham

AL

Disclosures

NN declares that he has no competing interests.

Cardiology Specialist Registrar

The James Cook University Hospital

Middlesbrough

UK

Disclosures

AT declares that he has no competing interests.

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