Bret Michaels' Stroke Tied to Hole in Heart

One in five people may have condition, doctors say, but stroke risk remains low.

ByKIM CAROLLO <br> ABC News Medical Unit
May 21, 2010, 6:28 PM

May 22, 2010&#151; -- Rocker and reality TV star Bret Michaels has a hole in his heart, a condition also known as patent foramen ovale, tests revealed this week -- and cardiologists say it's a condition he has in common with about 20 percent of the adult population.

Patent foramen ovale, or PFO, occurs when a small hole that helps circulate blood to the unborn fetus doesn't close after birth. Doctors say a PFO rarely causes any symptoms and doesn't impact the functioning of the heart. There are also no genetic factors known to predispose a person to PFO.

"What can sometimes happen, though, is small amounts of blood can go from one side to another and if there's blood clot in the veins, it can sneak across the hole, get into the arteries and go into the brain," said Dr. Robert Brown, chair of neurology at the Mayo Clinic in Rochester, Minn. This clot, he said, can block blood flow and lead to a transient ischemic attack (TIA) or stroke.

Doctors believe that Michaels' PFO led to a TIA. However, although millions of other people have PFO, they probably don't know about it. Brown says it's usually only detected through a test like an echocardiogram. But even if it gets detected, that doesn't mean a person has a higher risk for a TIA or a stroke.

"Since so many people have PFO, we would see a lot more young people having strokes if it were a risk factor," said Dr. Barry Love, a pediatric cardiologist at Mount Sinai Medical Center in New York.

"The challenge when PFO is detected is to sort out if a person is one of the small percentage of people who will get a TIA or a stroke," Brown said.

As a result, people who do have PFO should be very aware of habits that may cause blood clots to develop, such as being sedentary for long periods of time.

While PFO is very common, it is most often found in younger people who have strokes for no apparent reason.

"Young people having a stroke is uncommon," Love said, adding that the condition is found in half of younger adults like Bret Michaels who have had TIAs or strokes.

Both doctors said that, typically, the only symptoms of PFO are the symptoms associated with TIAs or strokes, such as numbness or paralysis on one side of the body, trouble speaking, trouble walking or a sudden, severe headache.

PFOs Often Go Undetected, Doctors Say

PFOs typically have no symptoms and are often left untreated, but if a person with PFO has a stroke or treatment is otherwise necessary, doctors will consider blood thinners, repairing the PFO surgically or using a plug to close it.

Despite the connection to strokes, PFOs are not linked to other medical conditions. Although he did not treat Bret Michaels and didn't speak specifically about the rocker's case, Brown said it was unlikely that the hole in Michaels' heart had anything to do with the brain hemorrhage he suffered weeks earlier.

"It sounds like a different issue altogether," he said.

And Love, who is also not involved in Michaels' treatment, said that without knowing anything about Michaels' medical or personal background, it's entirely possible that his stroke may have not have been related to his PFO.

"There are other risk factors for strokes as well," Love said.

Though it's unfortunate that Bret Michaels had to endure two major medical concerns in a short period of time, Brown said, there is at least one good thing that came out of his ordeal: Michaels sought medical attention after he felt numbness on one side of his body, which is a great lesson for everyone.

A positive element "any time a celebrity has a TIA or a stroke," he said, "is that it makes us aware that if you have those symptoms, you need to urgently seek care."

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