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Atrial Septal Defect


What is an atrial septal defect (ASD)?

An ASD is a hole in the septum (wall) between the upper chambers of your heart. The hole may be small or large. An ASD causes a problem with the way blood moves through your heart. This makes your heart work harder to pump blood.

What causes an ASD?

The cause of an ASD is not known. You may be at risk for an ASD if your mother had an infection while she was pregnant with you. Being born early or having a family history of ASD may also increase your risk.

What are the signs and symptoms of an ASD?

You may not have symptoms if your ASD is very small. If you do have symptoms, they may not appear until you are age 20 or older. You may have any of the following:

  • Fatigue
  • Feeling your heart skip a beat or flutter
  • Shortness of breath that is worse during exercise
  • Lips and fingernails turn blue with activity
  • Frequent colds or lung infections
  • Chest pain

How is an ASD diagnosed?

Your healthcare provider will listen to your heartbeat and check for a murmur. A murmur is an abnormal heart sound. You may also need any of the following:

  • An EKG test records your heart rhythm and how fast your heart beats. It is used to check for abnormal heartbeats and other heart problems.
  • X-ray, CT, or MRI pictures will show the size and location of the ASD. It may also show problems in your lungs or other places in your heart. You may be given contrast liquid to help your heart and lungs show up better in the pictures. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell the healthcare provider if you have any metal in or on your body.
  • An echocardiogram is a type of ultrasound. It uses sound waves to form pictures of blood flow through the arteries of the heart. The pictures show all 4 heart chambers, including valves, the lining, and the aorta. Doppler is used to measure how fast blood flows through the arteries. This test is called TTE if the sensor is placed on your chest or abdomen. It is called TEE if the sensor is placed down into your esophagus.
  • Cardiac catheterization is a procedure to check how well your heart is working. It is also used to measure pressure in different parts of your heart. A tube is put into your heart through a blood vessel in your leg or arm. You may be given contrast liquid to help your heart show up better in pictures. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid.

How is an ASD treated?

Treatment may depend on your symptoms and how large the ASD is. You may need any of the following:

  • Medicines may be given to control your heartbeat or decrease stress on your heart. Medicine may also be given to lower pressure in your lungs, prevent blood clots, or remove extra fluid.
  • Cardiac catheterization may also be used to close the ASD. The catheter is placed into an artery in your groin, neck, or arm and guided up to your heart. A small stitch, patch, or plug is used to close the hole.
  • Open heart surgery may be needed to close the ASD with stitches, a patch, or a plug.

What can I do to care for myself?

  • Maintain a healthy weight. Being overweight can increase your risk for high blood pressure, diabetes, and coronary artery disease. These conditions can make your symptoms worse. Ask your healthcare provider how much you should weigh. Ask him or her to help you create a weight loss plan if you are overweight.
  • Do not smoke. Nicotine and other chemicals in cigarettes and cigars can cause lung and heart damage. Ask your healthcare provider for information if you currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you use these products.
  • Do not drink alcohol. Alcohol can increase your risk for high blood pressure, diabetes, and coronary artery disease.
  • Eat heart-healthy foods and limit sodium (salt). Eat more fresh fruits and vegetables. Eat fewer canned and processed foods. Replace butter and margarine with heart-healthy oils such as olive oil and canola oil. Other heart-healthy foods include walnuts, whole-grain breads, low-fat dairy products, beans, and lean meats. Fatty fish such as salmon and tuna are also heart healthy. Ask how much salt you can eat each day.

  • Ask your healthcare provider if you need to limit your activity. You may need to avoid strenuous activities to decrease symptoms. Examples include running, weightlifting, and swimming. You may also need to avoid scuba diving or hiking in high altitudes. These activities may put too much stress on your heart.
  • Ask your healthcare provider about vaccines. Vaccines can help prevent infection. Infection can make your condition worse. You may need the pneumonia and flu vaccines.
  • Talk to your healthcare provider about pregnancy. If you are a woman and want to get pregnant, talk to your healthcare provider. Pregnancy may increase your or your baby's risk for problems.

Call your local emergency number (911 in the US) for any of the following:

  • You have any of the following signs of a heart attack:
    • Squeezing, pressure, or pain in your chest
    • You may also have any of the following:
      • Discomfort or pain in your back, neck, jaw, stomach, or arm
      • Shortness of breath
      • Nausea or vomiting
      • Lightheadedness or a sudden cold sweat
  • You have any of the following signs of a stroke:
    • Numbness or drooping on one side of your face
    • Weakness in an arm or leg
    • Confusion or difficulty speaking
    • Dizziness, a severe headache, or vision loss
  • You cough up blood.

When should I call my cardiologist?

  • You are short of breath at rest or more short of breath than usual during exercise.
  • Your lips or fingers are blue or white at rest.
  • Your heart is beating faster than usual or fluttering more than usual.
  • You feel dizzy or faint.
  • You have swelling in your legs or ankles.
  • You have severe abdominal pain or your abdomen is larger than usual.
  • You have a fever.
  • You have chills, a cough, or feel weak and achy.
  • You feel depressed.
  • You have questions or concerns about your condition or care.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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