An atrial septal defect
(ASD) is a hole in the wall between the two upper chambers of your
heart. The condition is present from birth (congenital). Smaller atrial
septal defects may close on their own during infancy or early childhood.
Large and long-standing atrial septal defects can damage your heart and
lungs. An adult who has had an undetected atrial septal defect for
decades may have a shortened life span from heart failure or high blood
pressure in the lungs. Surgery is usually necessary to repair atrial
septal defects to prevent complications.
Many babies born with atrial septal defects don't have signs or
symptoms. In adults, signs or symptoms usually begin by age 30, but in
some cases signs and symptoms may not occur until decades later.
Signs and symptoms of large or long-standing atrial septal defects may include:
* Heart murmur, a whooshing sound that can be heard through a stethoscope
* Shortness of breath, especially when exercising
* Swelling of legs, feet or abdomen
* Heart palpitations or skipped beats
* Frequent lung infections
* Bluish skin color
When to see a doctor
Contact your doctor if you or your child has any of these signs or symptoms:
* Bluish discoloration of the skin
* Shortness of breath
* Tires easily, especially after activity
* Swelling of legs, feet or abdomen
* Heart palpitations or skipped beats
These could be symptoms of heart failure or another complication of an atrial septal defect.
Doctors know that heart defects present at birth (congenital) arise from
errors early in the heart's development, but there's often no clear
cause. Genetics and environmental factors may play a role.
An atrial septal defect allows freshly oxygenated blood to flow from the
left upper chamber of the heart (left atrium) into the right upper
chamber of the heart (right atrium). There it mixes with deoxygenated
blood and is pumped to the lungs, even though it's already refreshed
with oxygen. If the atrial septal defect is large, this extra blood
volume can overfill the lungs and overwork the heart. If not treated,
the right side of the heart eventually enlarges and weakens. In some
cases, the blood pressure in your lungs increases as well, leading to
Comparing ASD with patent foramen ovale
The term "atrial septal defect" usually refers to a hole in the atria
resulting from a lack of atrial septal tissue, rather than those related
to a condition called patent foramen ovale (PFO).
Patent foramen ovale occurs when part of the normal fetal heart
circulation fails to close properly at birth. During fetal heart
development, a channel (the foramen ovale) is present between the atria
to allow blood to bypass the lungs. At birth, once the lungs take over
breathing, the hole normally closes. In about 1 in 3 people, this
opening doesn't close completely.
Scientists don't know why atrial septal defects occurs, but they do know
that this and other congenital heart defects appear to run in families
and sometimes occur with other genetic problems, such as Down syndrome.
If you have a heart defect, or you have a child with a heart defect, a
genetic counselor can estimate the odds that any future children will
When the following conditions occur during pregnancy, they can increase your risk of having a baby with a heart defect:
* Rubella infection. Becoming infected with rubella (German measles)
while pregnant can increase the risk of fetal heart defects.
* Drug or alcohol use or exposure to certain substances. Use of
certain medications, alcohol or drugs such as cocaine during pregnancy
can harm the developing fetus.
A small atrial septal defect may never cause any problems. Small atrial septal defects often close during infancy.
Larger defects can cause mild to life-threatening problems:
* Pulmonary hypertension. If a large atrial septal defect goes
untreated, increased blood flow to your lungs increases the blood
pressure in the lung arteries (pulmonary hypertension).
* Eisenmenger syndrome. In rare cases, pulmonary hypertension can
cause permanent lung damage, and it becomes irreversible. This
complication, called Eisenmenger syndrome, usually develops over many
years and occurs only in a small percentage of people with large atrial
Other potential complications of an untreated atrial septal defect include:
* Right-sided heart failure
* Heart rhythm abnormalities
* Shortened life expectancy
* Increased risk of a stroke
Treatment can prevent or help manage many of these complications.
Atrial septal defect and pregnancy
Most women with an atrial septal defect can tolerate pregnancy without
any problems. However, having a larger defect or having complications
such as heart failure, arrhythmias or pulmonary hypertension can
increase your risk of complications during pregnancy. Doctors strongly
advise women with Eisenmenger syndrome not to become pregnant because it
can endanger the woman's life.
The risk of congenital heart disease is higher for children of parents
with congenital heart disease, whether in the father or the mother.
Experts recommend that anyone with a congenital heart defect, repaired
or not, who is considering starting a family carefully discuss it
beforehand with his or her doctor. Some medications may need to be
stopped or adjusted before you become pregnant because they can cause
serious problems for a developing fetus.
Preparing for your appointment
An atrial septal defect may first be detected when a suspicious heart
murmur is heard during a routine examination. A heart murmur is an
abnormal whooshing sound caused by turbulent blood flow. If your doctor
suspects an atrial septal defect, you or your child will likely be
referred to a doctor who specializes in disorders of the heart
Because appointments can be brief, and there's often a lot of ground to
cover, it's a good idea to arrive well prepared. Here's some information
to help you get ready for your appointment, and what to expect from
What you can do
* Write down any symptoms you're experiencing, including any that
may seem unrelated to the reason for which you scheduled the
* Write down key personal information, including any major stresses or recent life changes.
* Make a list of all medications, as well as any vitamins or supplements, that you're taking.
* Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions
can help you make the most of your time together. List your questions
from most important to least important in case time runs out. For atrial
septal defect, some basic questions to ask your doctor include:
* What's the most likely cause of my symptoms?
* Are there other possible causes for my symptoms?
* What kinds of tests do I need? Do these tests require any special preparation?
* Is this condition temporary or long lasting?
* What are my treatment options?
* What are the risks of cardiac catheterization or surgery?
* Are there any alternatives to the primary approach that you're suggesting?
* I have other health conditions. How can I best manage them together?
* Are there any activity restrictions that I need to follow?
* Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?
In addition to the questions that you've prepared to ask your doctor,
don't hesitate to ask questions during your appointment at any time that
you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to
answer them may reserve time to go over any points you want to spend
more time on. Your doctor may ask:
* When did you or your child first begin experiencing symptoms?
* Have the symptoms been continuous, or occasional?
* Do your symptoms get worse when you exercise?
* Does anything else seem to make your symptoms worse?
* Is there anything that seems to improve the symptoms?
* Do you or does your child have any family history of heart problems?
* Do you or does your child have any family history of birth defects?
Tests and diagnosis
Your doctor may first suspect an atrial septal defect during a regular
checkup if he or she hears a heart murmur while listening to your heart
using a stethoscope. Or, an atrial septal defect may be found when an
ultrasound exam of the heart (echocardiogram) is done for another
If your doctor hears a heart murmur or finds other signs or symptoms of a
heart defect, he or she may request one or more of the following tests:
* Echocardiogram. This is a commonly used test to diagnose an atrial
septal defect. And, some atrial septal defects are found during an
echocardiogram done for another reason. In echocardiography, sound waves
produce a video image of the heart. It allows your doctor to see your
heart's chambers and measure their pumping strength. This test also
checks heart valves and looks for any signs of heart defects.
* Chest X-ray. An X-ray image helps your doctor see the condition of
your heart and lungs. An X-ray may identify conditions other than a
heart defect that may explain your signs or symptoms.
* Electrocardiogram (ECG). This test records the electrical activity of your heart and helps identify heart rhythm problems.
* Cardiac catheterization. In this test, a thin, flexible tube
(catheter) is inserted into a blood vessel at the groin or arm and
guided to your heart. Through catheterization, doctors can diagnose
congenital heart defects, test how well your heart is pumping and check
the function of your heart valves. Using catheterization, the blood
pressure in your lungs also can be measured. Doctors are investigating
catheterization techniques to repair heart defects as well.
* Magnetic resonance imaging (MRI). MRI is a technique that uses a
magnetic field and radio waves to create 3-D images of your heart and
other organs and tissues within your body. Your doctor may request an
MRI if echocardiography can't definitively diagnose an atrial septal
* Pulse oximetry. This painless test measures how well oxygen is
reaching your tissues. It helps detect whether oxygenated blood is
mixing with deoxygenated blood, which can help diagnose the type of
heart defect present. A small clip on your fingertip measures the amount
of oxygen in your blood.
Treatments and drugs
If your child has an atrial septal defect, your doctor may recommend
monitoring it for a period of time to see if it closes on its own, while
treating any symptoms with medications. Many atrial septal defects
close on their own during childhood. For those that don't close, some
small atrial septal defects don't cause any problems and may not require
any intervention. But, many atrial septal defects eventually require
surgery to be corrected.
If your child needs treatment, the timing of it depends on your child's
condition and whether your child has any other congenital heart defects.
Medications won't repair the hole, but they may be used to reduce some
of the signs and symptoms that can accompany an atrial septal defect.
Drugs may also be used to reduce the risk of complications after
surgery. Medications may include those to:
* Keep the heartbeat regular. Examples include beta blockers (Lopressor, Inderal) and digoxin (Lanoxin).
* Reduce the risk of blood clots. Anticoagulants, often called blood
thinners, can help reduce the chances of developing a blood clot and
having a stroke. Anticoagulants include warfarin (Coumadin) and
anti-platelet agents, such as aspirin.
Many doctors recommend repairing an atrial septal defect diagnosed
during childhood to prevent complications as an adult. For adults and
children, surgery involves plugging or patching the abnormal opening
between the atria. Doctors can do this through two methods:
* Cardiac catheterization. A thin tube (catheter) is inserted into a
blood vessel in the groin and guided to the heart. Through the
catheter, a mesh patch or plug is put into place to close the hole. The
heart tissue grows around the mesh, permanently sealing the hole.
* Open-heart surgery. This type of surgery is done under general
anesthesia and requires the use of a heart-lung machine. Through an
incision in the chest, surgeons use patches or stitches to close the
Follow-up care depends on the type of defect and whether other defects
are present. For simple atrial septal defects closed during childhood,
only occasional follow-up care is needed. For adults, follow-up care may
depend on any resulting complications.
Lifestyle and home remedies
If you find out you have a congenital heart defect, or you've had
surgery to correct one, you may wonder about limitations on activities
and other issues.
* Exercise. Having an atrial septal defect usually doesn't restrict
you from activities or exercise. If you have complications, such as
heart failure or pulmonary hypertension, you may not be able to do some
activities or exercises. Your cardiologist can help you learn what is
* Preventing infection. Some heart defects, and the repair of
defects, create changes to the surface of the heart in which bacteria
can become stuck and grow into an infection (infective endocarditis).
Atrial septal defects generally aren't associated with infective
endocarditis. But if you have other heart defects in addition to an
atrial septal defect, or if you've recently had atrial septal defect
repair, you may need to take antibiotics before certain dental or
In most cases, atrial septal defects can't be prevented. If you have a
family history of heart defects or other genetic disorders, consider
talking with a genetic counselor to assess what the risk might be before