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Is patent foramen ovale the culprit in women with migraine and cardiovascular disease?
International Journal of Cardiology 113 (2006) 442 www.elsevier.com/locate/ijcard
Letter to the Editor
Is patent foramen ovale the culprit in women with migraine and cardiovascular disease? Tsung O. Cheng ⁎ Department of Medicine, The George Washington University Medical Center, 2150 Pennsylvania Avenue, N.W., Washington, D.C. 20037, United States Received 17 September 2006; accepted 17 September 2006 Available online 16 October 2006
Keywords: Patent foramen ovale; Myocardial infarction; Paradoxical embolism
The recent report of an association between migraine with aura and increased risk of major cardiovascular disease, myocardial infarction, ischemic stroke and death due to ischemic cardiovascular disease in women [1] is most interesting. Among the many possible mechanisms postulated by the authors, the presence of a patent foramen ovale (PFO) responsible for these events by virtue of paradoxical embolism was raised. However, it was dismissed by the authors, because “This, however, is unlikely to explain the association between migraine with aura and coronary vascular events” [1]. Paradoxical embolism via a PFO can result in systemic embolization of a venous thrombus into not only the cerebral circulation causing ischemic stroke but also into the coronary circulation causing myocardial infarction [2]. In my first report of paradoxical embolism diagnosed during life published in 1976, one patient had coronary embolism with resultant acute myocardial infarction [2]. Subsequently I have written more on the importance of recognizing coronary embolism as a manifestation of paradoxical embolism [3–8]. I recently also reviewed the relation between migraine and PFO [9]. If paradoxical embolism can occur in the cerebral
⁎ Tel.: +1 202 741 2426; fax: +1 202 741 2324. E-mail address: [email protected]. 0167-5273/$ - see front matter © 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2006.09.002
circulation, there is no reason why it cannot occur in the coronary circulation. In fact it does occur. References [1] Kurth T, Gaziano JM, Cook NR, Logroscino G, Diener H-C, Buring JE. Migraine and risk of cardiovascular disease in women. JAMA 2006;296:283–91. [2] Cheng TO. Paradoxical embolism. A diagnostic challenge and its detection during life. Circulation 1976;53:565–8. [3] Cheng TO. Paradoxic embolism. Am Heart J 1996;131:1238. [4] Cheng TO. Coronary embolism. Am Heart J 1996;132:1314–5. [5] Cheng TO. Paradoxical embolism: diagnosis and management. J Emerg Med 2001;20:416–7. [6] Cheng TO. Right-sided chest-lead abnormalities on EKG in acute pulmonary embolism. J Natl Med Assoc 2003;95:862. [7] Cheng TO. Brugada syndrome vs pulmonary embolism vs paradoxical embolism. What are we to believe? Int J Cardiol 2004;94:119. [8] Cheng TO. Paradoxic coronary embolism as an alternative explanation for increased cardiac troponin in acute pulmonary embolism. Heart November 2004 [http://heart.bmjjournals.com/cgi/eletters/90/6/633 Accessed November 4, 2004]. [9] Cheng TO. Patent foramen ovale and migraine. Am J Cardiol in press.
Letter to the Editor
Is patent foramen ovale the culprit in women with migraine and cardiovascular disease? Tsung O. Cheng ⁎ Department of Medicine, The George Washington University Medical Center, 2150 Pennsylvania Avenue, N.W., Washington, D.C. 20037, United States Received 17 September 2006; accepted 17 September 2006 Available online 16 October 2006
Keywords: Patent foramen ovale; Myocardial infarction; Paradoxical embolism
The recent report of an association between migraine with aura and increased risk of major cardiovascular disease, myocardial infarction, ischemic stroke and death due to ischemic cardiovascular disease in women [1] is most interesting. Among the many possible mechanisms postulated by the authors, the presence of a patent foramen ovale (PFO) responsible for these events by virtue of paradoxical embolism was raised. However, it was dismissed by the authors, because “This, however, is unlikely to explain the association between migraine with aura and coronary vascular events” [1]. Paradoxical embolism via a PFO can result in systemic embolization of a venous thrombus into not only the cerebral circulation causing ischemic stroke but also into the coronary circulation causing myocardial infarction [2]. In my first report of paradoxical embolism diagnosed during life published in 1976, one patient had coronary embolism with resultant acute myocardial infarction [2]. Subsequently I have written more on the importance of recognizing coronary embolism as a manifestation of paradoxical embolism [3–8]. I recently also reviewed the relation between migraine and PFO [9]. If paradoxical embolism can occur in the cerebral
⁎ Tel.: +1 202 741 2426; fax: +1 202 741 2324. E-mail address: [email protected]. 0167-5273/$ - see front matter © 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2006.09.002
circulation, there is no reason why it cannot occur in the coronary circulation. In fact it does occur. References [1] Kurth T, Gaziano JM, Cook NR, Logroscino G, Diener H-C, Buring JE. Migraine and risk of cardiovascular disease in women. JAMA 2006;296:283–91. [2] Cheng TO. Paradoxical embolism. A diagnostic challenge and its detection during life. Circulation 1976;53:565–8. [3] Cheng TO. Paradoxic embolism. Am Heart J 1996;131:1238. [4] Cheng TO. Coronary embolism. Am Heart J 1996;132:1314–5. [5] Cheng TO. Paradoxical embolism: diagnosis and management. J Emerg Med 2001;20:416–7. [6] Cheng TO. Right-sided chest-lead abnormalities on EKG in acute pulmonary embolism. J Natl Med Assoc 2003;95:862. [7] Cheng TO. Brugada syndrome vs pulmonary embolism vs paradoxical embolism. What are we to believe? Int J Cardiol 2004;94:119. [8] Cheng TO. Paradoxic coronary embolism as an alternative explanation for increased cardiac troponin in acute pulmonary embolism. Heart November 2004 [http://heart.bmjjournals.com/cgi/eletters/90/6/633 Accessed November 4, 2004]. [9] Cheng TO. Patent foramen ovale and migraine. Am J Cardiol in press.