Atrial Septal Defect

Medically reviewed by Drugs.com. Last updated on May 4, 2025.

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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. An ASD can also lead to a stroke if a blood clot is pumped out to a blood vessel in your brain.

What causes an ASD?

The cause of an ASD is not known. Any of the following may increase your risk:

• A family history of ASD
• Being born early
• Mother's age during pregnancy was 35 years or older, or she had rubella early in her pregnancy
• Mother's use of alcohol or cigarettes during pregnancy
• Having another heart defect
• Use of thalidomide
• A high blood glucose (sugar) level

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:

• Not having any energy, or feeling very tired (fatigue)
• Feeling your heart skip a beat or flutter
• Shortness of breath that is worse during exercise
• Lips and fingernails turn blue with activity
• Colds or lung infections that happen often
• 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. Extra body weight can increase your risk for high blood pressure, diabetes, and coronary artery disease. These conditions can make your symptoms worse. Ask your healthcare provider what a healthy weight is for you. Your provider can help you create a safe weight loss plan, if needed.
• Do not smoke. Nicotine and other chemicals in cigarettes and cigars can cause lung and heart damage. Ask your provider for information if you currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your 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 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 provider about vaccines you may need. Vaccines can help prevent certain infections that can make your condition worse. Your provider can tell you if you should also get vaccines not listed below:
  • Get an influenza (flu) vaccine as directed. Get the vaccine as soon as recommended each year, usually in September or October.
  • Ask your healthcare provider about the pneumonia vaccine. The vaccine is recommended for all adults aged 50 or older to prevent pneumococcal disease, such as pneumonia. Adults aged 19 to 49 years who are at high risk for pneumococcal disease should also receive the vaccine. You may need 1 dose or 2. The number depends on the vaccine used and your risk factors.
  • COVID-19 vaccines are given to adults as a shot. At least 1 dose of an updated vaccine is recommended for all adults. COVID-19 vaccines are updated throughout the year. Adults 65 or older need a second dose of updated vaccine at least 4 months after the first dose. Your healthcare provider can help you schedule all needed doses as updated vaccines become available.
• Talk to your provider about pregnancy if you are female. Pregnancy may increase your or your baby's risk for problems. Your provider can help you plan a safe pregnancy or recommend birth control if you want to prevent pregnancy.

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 seek immediate care?

• 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.

When should I call my cardiologist?

• 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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