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Clinical features of secundum defect

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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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