Atrial Septal Defect: Symptoms, Diagnosis, and Treatment Options

Atrial septal defect (ASD)

Hello Doctor, I would like to ask you a question.
I have known since childhood that I have a congenital heart defect.
Although I can't engage in intense exercise, I have been generally fine otherwise.
The first time I had a complete heart examination was 15 years ago when I was pregnant, as I was concerned that my heart condition might pose risks during childbirth.
During the first three months of pregnancy, I experienced a rapid heartbeat and discomfort, but it improved later on.
After the examination, the doctor diagnosed me with an atrial septal defect and advised me to wait until after giving birth to return for a follow-up.
He recommended surgery, fearing that my condition might worsen with age.
After giving birth, I had another child a year later.
In daily life, I didn't feel much discomfort until two years ago when I started experiencing significant palpitations that made me uncomfortable.
I decided to visit a different hospital for another check-up.
The doctor also diagnosed me with an atrial septal defect, but he mentioned that my defect was not large and didn't believe it was the cause of my discomfort.
He conducted various tests, all of which came back normal.
The doctor concluded that my heart was beating faster than average, which was causing my fatigue, and prescribed medication to slow my heart rate.
He advised me to relax and manage my stress, which made me think that everything should be fine.
However, this year I have felt increasingly unwell, experiencing chest tightness, heart pain, rapid heartbeat, and sometimes difficulty breathing.
I returned to the doctor to see if there had been any changes.
He suggested that my symptoms might be due to stress and prescribed some anti-anxiety medication to try.
He planned to conduct further tests to check for any changes but insisted that my heart condition should not be causing any discomfort.
Despite this, I still feel unwell.
Even doing light housework in the morning leaves me breathless, and at times, I struggle to breathe at night due to chest tightness.
I would like to ask the doctor if I should seek a second opinion at another hospital to hear different medical advice.
I'm confused about whether my issues are psychological or if there is a problem with the doctor's recommendations.
Thank you, Doctor.

Xiao Yu, 30~39 year old female. Ask Date: 2020/07/02

Dr. He Dongjin reply Cardiology

Hello, it is recommended to visit a medical center for further examination.
If you are in central Taiwan, you can consult Dr.
Fu Yunqing, the director of the Children's Hospital affiliated with China Medical University, as he is an authority in this field.
Changhua Hospital cares about your well-being.

Reply Date: 2020/07/02

More Info

Atrial Septal Defect (ASD) is a congenital heart defect characterized by an opening in the atrial septum, the wall dividing the left and right atria of the heart. This condition can lead to various symptoms and complications, depending on the size of the defect and the amount of blood that flows through it. Understanding the symptoms, diagnosis, and treatment options for ASD is crucial for managing this condition effectively.

Symptoms of Atrial Septal Defect
Many individuals with ASD may not experience noticeable symptoms, especially if the defect is small. However, as the defect increases in size or if the individual ages, symptoms may become more apparent. Common symptoms include:
1. Shortness of Breath: This is often experienced during physical activity or exertion, as the heart struggles to pump enough oxygenated blood to meet the body's demands.

2. Fatigue: Individuals may feel unusually tired, especially after exertion, due to the heart's inefficiency.

3. Palpitations: Some patients report feeling their heart racing or fluttering, which can be distressing.

4. Chest Discomfort: This can manifest as chest pain or pressure, which may be mistaken for anxiety or other conditions.

5. Frequent Respiratory Infections: Children with ASD may experience more frequent lung infections due to increased blood flow to the lungs.

6. Cyanosis: In severe cases, a bluish tint to the skin, especially around the lips and fingertips, may occur due to low oxygen levels in the blood.

Diagnosis of Atrial Septal Defect
Diagnosis typically involves a combination of medical history, physical examination, and diagnostic tests:
1. Medical History and Symptoms: A thorough review of symptoms and any family history of congenital heart defects is essential.

2. Physical Examination: A healthcare provider may detect abnormal heart sounds (murmurs) during a physical exam.

3. Echocardiogram: This ultrasound test is the most common method for diagnosing ASD. It provides images of the heart's structure and function, allowing doctors to visualize the defect.

4. Electrocardiogram (ECG): This test records the electrical activity of the heart and can help identify any arrhythmias or other heart issues.

5. Chest X-ray: This imaging test can show the size of the heart and the blood vessels, indicating whether there is an overload of blood flow to the lungs.

6. Cardiac MRI or CT Scan: These advanced imaging techniques can provide detailed views of the heart's anatomy and blood flow.

Treatment Options for Atrial Septal Defect
The treatment for ASD depends on the size of the defect, the severity of symptoms, and the overall health of the patient:
1. Observation: If the ASD is small and not causing significant symptoms, doctors may recommend regular monitoring without immediate intervention.

2. Medications: While medications cannot close the defect, they can help manage symptoms. For instance, beta-blockers or anti-anxiety medications may be prescribed to help with palpitations and anxiety.

3. Surgical Repair: For larger defects or those causing significant symptoms, surgical intervention may be necessary. This can involve:
- Open-heart surgery: The defect is closed with a patch or stitches.

- Minimally invasive procedures: In some cases, a catheter-based approach can be used to place a closure device in the heart to seal the defect.

4. Follow-up Care: Regular follow-up with a cardiologist is essential to monitor heart function and any potential complications.

Conclusion
Given your history of ASD and the symptoms you are experiencing, it is crucial to seek a comprehensive evaluation from a cardiologist who specializes in congenital heart defects. If you feel that your current treatment plan is not addressing your symptoms effectively, seeking a second opinion from another healthcare provider may provide you with additional insights and options. It is important to advocate for your health and ensure that your concerns are taken seriously, especially when experiencing symptoms like chest pain, shortness of breath, and fatigue. Remember, effective management of ASD can significantly improve your quality of life.

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