Atrial septal defect history and symptoms

The development of symptoms associated with atrial septal defect relates to the size and severity of intracardiac shunting of blood across the defect. A large atrial septal defect will result in the presentation of symptoms at a younger age. However, smaller, less severe defects may be asymptomatic until adulthood. Smaller defects cause less hemodynamic disruptions. Symptoms such as difficulty breathing, exercise intolerance and fatigue may be seen. As a person ages, the potential for the development of symptoms increases. Adults, especially those over the age of 40, will become symptomatic. Nearly all adults with an atrial septal defect will present with symptom onset by the age of 60.

The presentation of atrial septal defect depends on size of the defect, amount of shunt, and associated anomalies. Depending on these, the patients can be asymptomatic and get diagnosed incidentally on examination done for other causes. Symptom onset can occur gradually as patient ages and the defect becomes more influential on the heart‘s functioning.^[1]. Thus, the patient may present in adulthood with symptoms due to right heart failure, pulmonary hypertension and arrythmias.

Specific areas of focus when obtaining a history from the patient include history of:^[2]

• Frequent respiratory or lung infections
• Difficulty breathing (Dyspnea)
• Tiring when feeding (infants)
• Shortness of breath when being active or exercising
• Skipped heartbeats or a sense of feeling the heartbeat
• Swelling of legs, feet, or stomach area
• Stroke

• Shortness of breath, especially when exercising
• Fatigue especially with exertion/exercise
• Poor growth/failure to thrive
• Swelling of feet and ankle or abdomen (right sided heart failure)
• Heart palpitations or skipped beats (racing heart, awareness of heart beats)
• Recurrent respiratory infections

• Weakness of different parts of body (stroke) due to paradoxical embolization^[3][4]
• Migraine
• Bluish skin color or cyanosis

Atrial septal defect patients are often asymptomatic until later in life. The majority of people with atrial septal defects may not experience any symptoms until after the age of 40. Nearly all atrial septal defect patients will manifest symptoms by the age of 60. Symptoms may become more rapid in onset as patients get progressively older.

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