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Clinical features common to primum and secundum defect

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Small defects cause no abnormalities and are associated with normal development. Larger defects may cause:

  • exercise intolerance with easy fatiguability
  • frequent chest infections
  • atrial dysrhythmias, especially atrial fibrillation, may occur, the incidence increasing with age
  • in later life, there is the possible development of right heart failure

Other features may include:

  • prominent V waves in the JVP
  • narrow arterial pulse pressure
  • normal blood pressure, unless complicated by atrial fibrillation
  • hyperdynamic cardiac impulse with parasternal heave
  • hepatomegaly if there is cardiac failure
  • S1 loud, sometimes split
  • S2 widely split, fixed, unchanged on respiration
  • a loud S2 implies increased pulmonary resistance
  • there are no murmurs of the defect because the defect is large with no pressure gradient across it.
  • ejection systolic murmur over the pulmonary area - due to blood flow over the pulmonary valve, not the defect
  • short mid-diastolic ejection murmur heard over the tricuspid area
  • in ostium primum defects there may be associated mitral incompetence
  • murmurs are louder on inspiration because of increased venous return

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