A Young Woman's Years-Long Struggle with Unexplained Headaches Reveals an Underlying Atrial Septal Defect

Headaches are a common complaint, but when they persist for years without a clear cause, it's essential to look beyond the obvious. This case study follows a 34-year-old woman who experienced recurring headaches and dizziness for over four years. Despite multiple visits to various hospitals and treatments targeting neurological symptoms, she found no lasting relief. It wasn't until a comprehensive cardiac evaluation that the root cause was finally uncovered—an atrial septal defect (ASD), specifically a central-type patent foramen ovale (PFO).

Diagnosed at The Second Affiliated Hospital of Anhui Medical University in March 2022, the patient underwent a successful minimally invasive procedure to correct the defect. Her treatment included a percutaneous transcatheter ASD closure via femoral vein access, followed by a short course of aspirin therapy to prevent thrombosis. After just four days of hospitalization, her symptoms had resolved, and follow-up imaging confirmed a successful outcome with no residual shunting.

Understanding Atrial Septal Defects and Their Impact

Atrial septal defects are a type of congenital heart condition characterized by an abnormal opening in the wall between the heart's two upper chambers. In this case, the patient's PFO—a small flap-like opening that didn't close after birth—was responsible for a left-to-right shunt. While many people live their entire lives without knowing they have a PFO, in some cases, it can lead to neurological symptoms such as migraines, dizziness, and even strokes.

Initial Evaluation and Diagnostic Clues

The patient had suffered from persistent left-sided headaches and occasional dizziness for over four years. Despite multiple visits to neurology departments and treatments with pain medications, no improvement was seen. Her physical exam revealed a soft systolic murmur at the left sternal border, prompting further cardiac investigation. A transthoracic echocardiogram confirmed the diagnosis of a central atrial septal defect measuring approximately 11×11×11mm. Brain CT and ECG results were otherwise normal, reinforcing the need for a cardiology-focused approach.

Treatment Plan and Intervention

With a clear diagnosis established, the patient was scheduled for a catheter-based closure procedure. Under ultrasound guidance and general anesthesia, a percutaneous closure device was deployed through the femoral vein. This minimally invasive technique avoids radiation exposure and allows for a quicker recovery. The next day, she began taking low-dose aspirin to prevent clot formation around the closure device. Within days, her headaches and dizziness had completely resolved.

Postoperative Recovery and Follow-Up

Three days after the procedure, a follow-up echocardiogram confirmed the device was securely in place with no residual shunting. She was discharged on the fourth day with no symptoms and instructed to return for a one-month follow-up. At her follow-up visit, she remained symptom-free, and imaging continued to show optimal placement of the closure device. Aspirin therapy was continued for six months post-procedure to ensure full recovery.

Key Considerations After ASD Closure

While the patient's recovery was smooth, several important points must be emphasized for long-term care:

Avoid strenuous physical activity for the first few months to prevent device displacement.
Continue aspirin therapy as prescribed to reduce the risk of thromboembolic events.
Avoid MRI scans unless specifically cleared by a cardiologist due to the metallic components of the closure device.
Regular follow-ups including echocardiograms and blood tests to monitor platelet levels during anticoagulant therapy are crucial.

Clinical Insights and Recommendations

This case highlights the importance of a multidisciplinary approach in diagnosing unexplained neurological symptoms. In adults presenting with recurrent migraines, dizziness, or even cryptogenic stroke, a thorough cardiac evaluation—including bubble study echocardiography—should be considered. Percutaneous closure of ASD or PFO is now a well-established, safe, and effective treatment option with excellent long-term outcomes.

Early diagnosis and timely intervention are key to preventing complications and improving quality of life. As this case demonstrates, a persistent, unexplained headache may not always be neurological in origin—sometimes, the answer lies within the heart.