Clinical features common to primum and secundum defect

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