Clinical features of primum defect
The clinical features include:
- heart failure: this in infancy or childhood
- pulmonary hypertension: especially in Downs syndrome - pulmonary ejection systolic murmur and mid-diastolic tricuspid murmur reflecting increased flow
- cardiac enlargement
- breathlessness at rest
- Harrison's sulci – indentation on the chest along the 6th rib, which is usually bilateral but can also occur unilaterally
- pink with normal pulses
- apical pansystolic murmur: if the mitral valve is incompetent
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