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Clinical features common to primum and secundum defect

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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

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