Patient education: Atrial septal defects in adults (The Basics)

What is an atrial septal defect? — An atrial septal defect ("ASD") is a hole between 2 sections of the heart. The heart is divided into 4 spaces, called "chambers." People with an ASD have a hole between the 2 upper chambers called the "atria" (figure 1). Having a large- or medium-sized hole can change how blood flows through the heart. Also, it can make the heart work harder than it should. This can cause health problems.

A person who has an ASD was born with it. ASDs are often found by a doctor in childhood, but in some cases, an ASD is not found until the person is an adult. It might be found when it starts causing symptoms, or unexpectedly when the person is getting tests for another reason.

What are the symptoms of an ASD? — Many people with an ASD have no symptoms for years. Small ASDs usually close by 2 to 5 years of age, and don't cause problems.

If a large- or medium-sized ASD is not found and treated, it can cause symptoms as a person gets older, usually by age 40. These can include:

●Abnormal heartbeat – Your heart might feel like it is racing or skipping beats.

●Trouble exercising or doing other physical activities – You might also get tired easily just from normal daily activities.

●Trouble breathing

●Skin that looks blue

An ASD can also sometimes cause a heart murmur. This is an extra sound doctors or nurses hear when they listen to the heartbeat with a stethoscope.

Should I see a doctor or nurse? — Yes. If you feel like your heart is beating abnormally, or if you have trouble breathing or get tired very easily, see a doctor or nurse. They will do an exam, listen to your heart, and do tests.

Will I need tests? — Yes. If the doctor or nurse thinks you might have an ASD, they can order the following tests:

●An electrocardiogram (ECG) – This test measures the electrical activity in the heart. It might show a pattern of abnormal electrical activity.

●A chest X-ray – A chest X-ray might be normal, or show changes to the heart or lungs caused by a large ASD.

●An echocardiogram – This test uses sound waves to create a picture of the heart as it beats. It can show the size of the hole in your heart. It can also show exactly where the hole is and if there are other heart problems.

How is an ASD treated? — If your ASD is large- or medium-sized or causing symptoms, you will most likely need a procedure to close it. This can be done in different ways, depending on where the hole is:

●A procedure called "transcatheter closure" – In this treatment, a doctor places a thin tube into a blood vessel in an arm or leg. Then, they move the tube through the blood vessel to the heart. When the tube gets to the hole in the heart, the doctor uses the tube to put in a small device that closes the hole.

●Surgery to patch the hole

Even if your ASD is repaired, you might still need treatment for related problems. For example:

●If you have an abnormal heartbeat, this can be treated with different medicines and procedures.

●If you have high blood pressure in the blood vessels that go from the heart to the lungs (a condition called "pulmonary hypertension"), you might need medicines or other treatments.

If you have an ASD that is not repaired, you will need to see your doctor regularly. How often you need to see them depends on your situation. You will need to go more often if you have symptoms or other heart problems. Your doctor will do an exam and tests to check how your heart is working.

What if I want to get pregnant? — If you have an ASD and want to get pregnant, talk to your doctor before you start trying.

If you have a small ASD that is not causing symptoms, this will probably not affect your ability to have a normal pregnancy. But your doctor will monitor you and your baby closely to check for any problems. They might also talk to you about ways to avoid getting blood clots in your veins.

If you had surgery to close an ASD in the past, and you no longer have related symptoms, this will also probably not affect pregnancy.

In some situations, like if you have pulmonary hypertension, pregnancy could be dangerous for both you and your baby. (Pulmonary hypertension is high blood pressure in the blood vessels that go from the heart to the lungs.) Your doctor can talk to you about your personal risks and options.

Some people wonder if their baby will be born with an ASD, too. In most cases, ASDs do not run in families. But some ASDs are related to an abnormal gene that you could pass on to your children. Your doctor will talk to you about how likely this is based on your situation.

More on this topic

Patient education: Heart murmurs (The Basics)
Patient education: Echocardiogram (The Basics)
Patient education: Patent foramen ovale (The Basics)
Patient education: Atrial fibrillation (The Basics)
Patient education: Pulmonary hypertension (The Basics)