Written by: Dr Ranjan Shetty
4 min readDec 16, 2025 05:28 PM IST
First published on: Dec 16, 2025 at 04:19 PM IST
As we continue to document the many reasons for young heart attacks in the country, there are some less talked about triggers. About five years ago, I had a 35-year-old executive come into the emergency following a road crash. He needed leg surgery, which was successful. But the next day he had a heart attack, a biggish clot blocking his left anterior descending artery (LAD), the largest coronary artery. What went wrong?
When we removed the blood clot to restore blood flow, I was surprised to find that such a big clot had happened in an artery which was otherwise very clean. Not only that, this blood clot was too reddish, something that we do not see with plaque tears and subsequent clotting. And then we found a small hole in the heart, one that exists in one among four people, from where the clot had slipped through, floating up from blood vessels in his leg. Such flap problems in the heart are often a trigger for heart attacks and strokes.
A type of hole in the heart that can be a risk factor
About 25 per cent of the population have one type of hole in the heart called a patent foramen ovale (PFO). Now the reason it is undetected is because it does not cause adverse health effects. That’s why those affected do not even know about it till they develop some kind of condition.
In other words, this is a congenital heart defect. So, what exactly happens with a PFO? The foramen ovale is a hole with a flap in the wall between the left and right atria of every human foetus. This hole allows blood to bypass the foetal lungs, which cannot work until air is inhaled after birth. Once the newborn breathes after birth, the blood pressure changes and the flap closes. Except in some cases, it doesn’t.
Now for many people living with the condition, the PFO really doesn’t cause much problem, even though a small amount of blood can leak from the left to the right atrium, causing a slight increase in blood flowing to the lungs. Now if that blood contains a clot, it can travel elsewhere in the heart and even the brain.
Why my patient had a heart attack
Since my patient had severe leg trauma post the road crash and surgery, a clot had moved up from the affected blood veins in his leg and was in circulation. It made its way to the heart. Which is why the clot that we removed from his heart had seemed unfamiliar. I tested him for PFO, with what we call a bubble test. In this, we inject saltwater solution into your blood vessels. An echocardiogram can show the bubbles as they pass through a PFO in your heart. We were right in assessing the condition.
Closing the gap
To close the hole, we plant a device in the heart chamber through a catheter. Within a few days of receiving a PFO closure device, the body’s own tissue will start to grow over and around it. Three to six months later, the heart tissue grows around it and completely seals the device in. Today, the young man leads a perfectly normal life. He comes for his follow-ups and is cautious about his diet and exercise routines. His heart is functioning better than ever.
(Dr Shetty is lead cardiologist and medical director, Sparsh Hospital, Bengaluru)
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The doctor found a small hole in the heart, one that exists in one among four people, from where the clot had slipped through. (Credit: Unsplash) 
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