Congenital heart disease: The Daily PANCE Blueprint

The answer is C. Patent foramen ovale

Patent foramen ovale (PFO) is a remnant passageway that persists between the right and left atrium after birth in approximately 25% of the population. While usually asymptomatic and clinically insignificant, it can predispose to paradoxical emboli if a thrombus formed in the venous system passes through the PFO and enters the arterial system, leading to events such as a transient ischemic attack (TIA), especially in patients with no other cardiovascular risk factors. This patient’s sudden neurological symptoms that resolved quickly are characteristic of a TIA, likely caused by a paradoxical embolism through a PFO.

Incorrect Answer Explanations:

• A. Atherosclerosis: Typically contributes to cardiovascular events through arterial plaque formation and is a less likely cause in a young patient with no other risk factors.
• B. Marfan syndrome: Primarily affects connective tissue and, while it can impact cardiovascular structures, does not directly cause transient ischemic attacks through mechanisms associated with PFOs.
• D. Rheumatic heart disease: Leads to valvular heart damage secondary to rheumatic fever and does not involve interatrial septal defects or directly cause paradoxical emboli.
• E. Chronic hypertension: Usually contributes to cerebrovascular accidents through mechanisms like cerebral vessel rupture or blockage, not through paradoxical embolism which is typical of PFO-related events.