Atrial septal defect

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Hi there!

You’re looking at a short reference article from Explain Medicine (one of four distinct learning formats available in Clinical Odyssey). Try it out, and have fun improving your clinical skills.

Pediatrics

Last updated on:
January 25^th, 2023

Pediatrics

Last updated on:
January 25^th, 2023

Hi there!

You’re looking at a short reference article from Explain Medicine (one of four distinct learning formats available in Clinical Odyssey). Try it out, and have fun improving your clinical skills.

Clinicals - History

Fact	Explanation
No symptoms	Small atrial septal defects (ASD) (i.e., <5 mm in diameter) are generally asymptomatic during childhood—and possibly for the entire lifespan of the affected person. Even large ASDs (i.e., >10 mm in diameter) may be asymptomatic in childhood, only producing symptoms after the third decade of life.
Frequent respiratory infections	Infants with large ASDs may present with frequent respiratory infections. This is due to the increase in pulmonary blood flow secondary to left-to-right shunting.
Dyspnea	In infants this may manifest as a difficulty in feeding; this is due to increased fatigability. Older children may complain of exertional dyspnea. In some cases, dyspnea may be the only clue to underlying heart failure. Dyspnea occurs due to the abnormal increase in pulmonary blood flow secondary to left-to-right shunting.
Palpitations	Palpitations secondary to arrhythmias mainly occur in adults; but can occur in children.
Cyanosis	Rarely, cyanosis may occur if shunt reversal occurs. Shunt reversal occurs in severe pulmonary hypertension, when pressures of the right heart exceed those of the left heart.

No symptoms

Small atrial septal defects (ASD) (i.e., <5 mm in diameter) are generally asymptomatic during childhood—and possibly for the entire lifespan of the affected person. Even large ASDs (i.e., >10 mm in diameter) may be asymptomatic in childhood, only producing symptoms after the third decade of life.

Frequent respiratory infections

Infants with large ASDs may present with frequent respiratory infections. This is due to the increase in pulmonary blood flow secondary to left-to-right shunting.

Dyspnea

In infants this may manifest as a difficulty in feeding; this is due to increased fatigability. Older children may complain of exertional dyspnea. In some cases, dyspnea may be the only clue to underlying heart failure. Dyspnea occurs due to the abnormal increase in pulmonary blood flow secondary to left-to-right shunting.

Palpitations

Palpitations secondary to arrhythmias mainly occur in adults; but can occur in children.

Cyanosis

Rarely, cyanosis may occur if shunt reversal occurs. Shunt reversal occurs in severe pulmonary hypertension, when pressures of the right heart exceed those of the left heart.

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