Dr. Hive - Intracardiac shunt?

[Night Elf]

After my TIA in early March, I was referred to a neurologist. She decided to see if it may have been cardiac related so she had me do an echocardiogram. It was really weird. Besides taking measurements of every part of my heart or whatever he was doing, they did a bubble test where they shot saline bubbles through an IV and into my heart to see if there was a hole in my heart. I was watching the monitor and I didn't see any bubbles crossover. 

Today I get an email from my neurologist saying everything looked good but that I had an intracardiac shunt. It's not urgent or an emergency but she wants me to discuss it with a cardiologist. 

I tried reading about it and am trying to decide if this is something I should be concerned about. I sent an email to my primary care provider to ask her if I need a referral to a cardiologist. I don't think I do but I do want to keep her in the loop on what they're doing to me and what they're finding.

Any experiences?

[kbutton]

I come from a family with a lot of heart defects, and most of the time, our family members have gotten crappy advice. So, I would shop carefully for a cardiologist knowledgeable about congenital heart defects (a shunt is a congenital defect) and how to treat them in adults. We also know a man who had a couple of "small" congenital heart issues that almost died from several unlikely things happening at once. No one had really thought through what "could" happen, just that issues x and y were not necessarily a super big deal. Well, he now has a new cardiologist, but he had to almost die to get a competent one! 

http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/congenital-heart-disease-in-the-adult/

Quote

• Simple shunt lesions (ASD, VSD, and PDA) are the most common forms of CHD and can lead to right heart chamber enlargement, pulmonary hypertension, and arrhythmias.

You don't want any of those things if it can be prevented. Just because "you've probably always had it," it doesn't mean that it will never lead to some kind of deterioration. You need to be followed to be sure nothing develops.

I am hoping you are in the category of "it never caused a problem," but I think you should find an expert who doesn't leave that to chance.

[Night Elf]

It's so hard to know when I have a good doctor. I have Kaiser so I take who they give to me unless I know who I want them I tell them to make an appointment with that person. I don't know of any cardiologists. 

[kbutton]

3 hours ago, Night Elf said:

It's so hard to know when I have a good doctor. I have Kaiser so I take who they give to me unless I know who I want them I tell them to make an appointment with that person. I don't know of any cardiologists. 

I think in addition to Fifiruth's suggestion, looking at hospitals that deal with congenital heart defects and/or cardiac genetics is a good idea. Then, ask them who they think is the best person for your particular issue. Or the top 2-3 if you are in a big enough area.

You can find a lot on a hospital website these days, and you are probably wanting someone who does "clinic" based care, meaning they run "clinic" days in specialty areas--every Monday, for instance, they see patients with congenital issues or another day, they see patients with aortic disease. In clinics like this, they sometimes bring in a multi-disciplinary team of cardiologists, geneticists, etc. In a case where someone might have pulmonary issues too, they might bring in a pulmonologist. Usually these kinds of appointments are yearly (or whatever interval is customary with a person's issues), and they do your periodic screenings (echo, EKG, other testing), and then you see the "team" all at once so they can talk about the overlapping issues or what else you might expect. They will give you referrals for anything related that you need at this time too. You can call between appointments, but it's nice to have one appointment instead of 3 or 4 (though the appointment slot is long and you wait a bit while you are there).

You might very well not need this level of care, but if you get connected to a hospital that offers this kind of care, you are more likely to get a doctor that will be very up-to-date on your issue.

Best wishes!

[Night Elf]

I did look up doctors and Emory Hospital in Atlanta was the only one to come up. I'll keep it in mind.