clinical features common to primum and secundum defect
Last reviewed 01/2018
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