An eejits guide to PFO’s
A what?
A PFO is a hole in your heart. The heart is divided into four chambers, the atria and the ventricles. When we are in the womb, the blood doesnt need to go through the lungs as it gets oxygen via the placenta. So the heart actually has a hole in it – a patent foramen ovale which allows the blood to pass through the heart without going via the lungs. When we are born it closes up, but in a much debated percentage of people (between ¼ and 1/3 and all numbers between I have heard) it remains open.
This is non-symptomatic – it causes no problems for the majority of people, although it has been linked with migraines and strokes in later life. However, when we dive, any bubbles in the blood can pass through this hole and not get trapped in the lungs, meaning we get bent much more easily.
So why are you getting a test?
I got bent last year in Scapa Flow. It wasn’t undeserved, I royally deserved to get bent as a bent thing, but because I got a skin bend – highly indicative of a PFO, they decided I needed a test.
So what happens then?
Well once you have been straightened out and they have said you need a test, your GP needs to refer you. Once referred be prepared for a long wait. I have waited 5 months so far, and am now hopefully nearly there. Your diving doctor (see the BSAC website under medical referees for your nearest one) will be able to advise you as to if you can dive before the test. I was told no, but some people are allowed with hefty restrictions.
Also be aware that you can no longer self certify yourself fit to dive. It is one of the questions on the form – have you ever suffered from decompression illness.
The tests.
Once you get your appointment through, it is worth checking to see if you have been referred for the right test. I wasn’t – you need contrast to see if there are bubbles passing through the septum of the heart. The cardiology department insisted they could see the septum on a normal echocardiogram. They cant. Honest.
There are two main ways of telling if you have a holey heart.
Transthoracic Echocardiogram
This is where they use an ultrasound machine to look at the heart, while they inject bubbly saline into a vein. As they watch, they can see the bubbles pass through any holes. This is what is meant by contrast – the bubbles provide the contrast. This test only confirms the presence of a hole, not the size.
Transoesophageal Echocardiogram
This is pretty nasty, as tests go. Because the heart is protected by the ribs etc, it is difficult to get a good image of it from outside. So you get to swallow the echosounder probe. I am assured it is not pleasant at all. However, it is accurate, and from this you can see not only the presence of a hole, but also the size of any hole.
What after that then?
Well once you have your result you are either hole-less or holey. You can get the holes fixed on the NHS, but as far as I can gather, it is a bit of a battle. I think a lot of it is up to your GP and consultant as to how worthwhile they see the fixing of the hole. You can, of course, go private for all of this and get it done quickly. However, it is very expensive, you are talking five figures including the tests and closure procedure.
So, the moral of the tale?
Don’t get bent
Get BUPA if you can.
