On Jan. 29, 2014, Pittsburgh Penguins defenseman Kris Letang was in the middle of a great season. The 26-year-old Stanley Cup winner had scored 10 goals in only 34 games, and he was preparing for an away game in Los Angeles. Initially, his symptoms seemed minor.

“The first one was dizziness,” Letang said. “I had no sense of balance. I woke up that morning, went to the bathroom, and I tried to stand up, but I couldn’t—the room was spinning around me. I was stuck with headaches and dizziness.”

Team doctors ran multiple tests on Letang and determined he’d had a mild stroke. Sudden dizziness or trouble walking is a common stroke symptom, along with slurred speech, numbness in the face or extremities, blurred vision and severe headache.

A hole in the heart

It was an unusual diagnosis for a man his age, let alone one in excellent physical condition. The likely cause was a congenital hole in his heart, a patent foramen ovale.

“English is not my first language, and when they told me about it, I couldn’t understand,” Letang said, “so I called my wife and she told me, and she started crying.”

“You battle the fact that you don’t know if you’re going to come back the same as you were before.”

The two upper chambers of the heart are separated by the septum, a wall of muscle. According to the Cleveland Clinic, all fetuses have a small hole in the septum that allows the efficient delivery of oxygen before the lungs are in use. In most people, this hole closes at birth, but it doesn’t close completely in 25 percent of newborns, and Letang was one of them. A small clot probably slipped through the hole and traveled to his brain.

A PFO can be easily detected with an echocardiogram, an ultrasound of the heart. According to the U.S. Centers for Disease Control and Prevention, the 40-minute procedure can detect other heart defects even before birth, or it can determine the severity of a PFO in children or adults and help doctors determine the proper treatment.

The road to recovery

Letang was put on blood thinners and had to sit out games. “The week after, that was the worst,” he said. “I was always dizzy and having trouble finding my way. Driving—when everything was coming at me—I couldn’t really sense how far away they were.”

But Letang followed the advice of his doctors and let his body recuperate, despite his desire to get back on the ice. “You battle the fact that you don’t know if you’re going to come back the same as you were before,” he said. “I was not allowed to be with any other guys on the ice or get hit, but I was out there so I would be able to play again.”

After 10 weeks, Letang rejoined his team in time for the end of the season. A year and a half after his stroke, he continues to monitor his health, but as a survivor, he says, “The first thing is smile that you’re still alive.”