clinical features of secundum defect

Last reviewed 02/2022

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