Clinical features of secundum defect
Patients are usually asymptomatic throughout infancy and childhood, often presenting in the third or fourth decades of life. Rarely the symptoms include:
- breathlessness on exertion
- recurrent chest infections
On examination:
- the child is pink with normal pulses
- there is a right ventricular heave
- there is a murmur in the 2nd intercostal space in the left parasternal region - this is usually a flow murmur across a normal valve
- if the ASD is large there may be a similar murmur across the tricuspid valve
- the second sound is split because the over-filled right atrium takes longer to empty
- the splitting is fixed because the atria act as a single unit and therefore inspiration affect them both equally
- mitral valve prolapse has been demonstrated in up to 30% of patients with ostium secundum ASD
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