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PubMed This is a summary of 20 peer-reviewed journal articles Updated
Cardiology

Recognizing the Signs: When a Connection Causes Symptoms

At a Glance

Symptoms of an interatrial communication, such as an ASD or PFO, can be subtle or silent for years. In children, signs include frequent respiratory infections and poor growth, while adults often experience shortness of breath, fatigue, and heart palpitations.

It is common for an interatrial communication to be “silent,” meaning it produces no noticeable symptoms for years or even decades [1]. Because the heart is an adaptable organ, it often compensates for these small openings. However, when symptoms do emerge, they can be subtle and easily mistaken for other conditions like asthma, general “being out of shape,” or even normal aging [2][3].

Symptoms in Children and Infants

In pediatric patients, the heart is often resilient enough that they don’t feel “chest pain” or traditional heart symptoms. Instead, the signs are often related to pulmonary overcirculation—too much blood flowing to the lungs [2][4].

  • Frequent Respiratory Infections: Because the lungs are “wetter” due to extra blood flow, children with an Atrial Septal Defect (ASD) may get more frequent or more severe chest colds and pneumonia [2].
  • Poor Growth (Failure to Thrive): The heart and lungs are working so hard to move extra blood that the body burns more calories than usual. This can lead to slow weight gain or difficulty growing at a standard rate [2].
  • Exercise Intolerance: A child might not complain of being tired but may naturally avoid high-energy sports or take more frequent breaks than their peers during active play [2].

Symptoms in Adults

For many adults, the first sign of an ASD is a gradual, almost unnoticeable decline in stamina [2]. This is often caused by right heart volume overload, where the right side of the heart begins to stretch and weaken from processing too much blood [5][6].

  • Dyspnea on Exertion: This is the medical term for feeling short of breath during physical activity [2]. You might find that a flight of stairs or a brisk walk now leaves you winded.
  • Fatigue: A general, persistent sense of tiredness that doesn’t go away with rest [3].
  • Heart Palpitations: You may feel like your heart is skipping a beat, fluttering, or racing. This is often due to atrial arrhythmias, like atrial fibrillation, caused by the upper chambers of the heart being stretched out [7][8].

The Unique Role of PFO and the Brain

A Patent Foramen Ovale (PFO) is rarely “felt” by the heart itself because it doesn’t usually cause the same volume overload as an ASD. Instead, its symptoms are often neurological [9].

  • Cryptogenic Stroke: This is a stroke with no known cause. In some younger people, a small blood clot can travel through the PFO (bypassing the lungs) and go straight to the brain [10][11].
  • Migraine with Aura: There is a documented link between PFOs and migraines that start with an “aura” (visual disturbances like flashing lights) [12][13]. Some researchers believe chemicals that should be filtered by the lungs are slipping through the PFO and triggering these headaches [12]. Note: While this link is well-documented, medical guidelines do not currently recommend closing a PFO solely to cure or prevent migraines.

What Happens if Left Untreated?

It is important to remember that severe complications from an ASD usually only happen after many decades of leaving a large, hemodynamically significant hole untreated [14]. Modern monitoring and treatment plans are specifically designed to prevent these outcomes:

  1. Right-Sided Heart Failure: Over decades, the heart can become too tired to pump effectively, leading to swelling in the legs or abdomen [14][8].
  2. Pulmonary Hypertension: The blood pressure in the lung arteries can rise over a long period, making it even harder for the heart to pump [15][16].
  3. Eisenmenger Syndrome: In extremely rare, advanced cases of long-standing, uncorrected shunts, the lung damage becomes permanent, and the flow of blood through the hole reverses, causing the skin to look blue (cyanosis) [15][17].

Looking for “The Great Mimics”

Doctors must carefully rule out other conditions that look like ASD or PFO. For example, HFpEF (Heart Failure with preserved Ejection Fraction) also causes shortness of breath and exercise intolerance [2][18]. Advanced imaging like an echocardiogram is essential to prove that the symptoms are coming from a hole in the heart and not from a “stiff” heart or lung disease [19][20].

Return to the Home Page

Common questions in this guide

Can a hole in the heart cause symptoms in adults?
Yes, while often silent for years, adults with an atrial septal defect (ASD) may gradually experience shortness of breath during exertion, persistent fatigue, or heart palpitations. These are typically signs of right heart volume overload.
What are the signs of an ASD in infants and children?
Children with an ASD may experience frequent respiratory infections, poor growth, or exercise intolerance. Because the lungs receive extra blood flow, they have to work harder and burn more calories, which can impact a child's weight gain and energy.
How is a patent foramen ovale (PFO) related to migraines and strokes?
A PFO can allow small blood clots or unfiltered chemicals to bypass the lungs and travel directly to the brain. This has been linked to cryptogenic strokes (strokes with no known cause) and migraines that occur with visual auras.
What happens if an atrial septal defect is left untreated?
If a large ASD is left untreated for many decades, it can cause the right side of the heart to stretch and weaken. This can eventually lead to right-sided heart failure, pulmonary hypertension, or, in rare cases, irreversible lung damage known as Eisenmenger Syndrome.
How do doctors know if my symptoms are from an ASD?
Doctors use advanced imaging, such as an echocardiogram, to look at the structure and function of your heart. This test helps confirm whether symptoms like shortness of breath or fatigue are caused by a hole in the heart rather than other lung or heart conditions.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Is the defect currently 'hemodynamically significant,' meaning it is changing the shape or size of the heart?
  2. 2.Could my fatigue or shortness of breath be attributed to an ASD, or is it more likely related to another condition?
  3. 3.For a child: Is their growth pattern normal, or could the heart defect be causing them to burn extra calories?
  4. 4.What are the specific signs of 'right heart volume overload' on my recent echocardiogram?
  5. 5.If I have migraines with aura, how does this impact my overall care plan, even if closure isn't recommended solely for migraines?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (20)
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    Think beyond right bundle branch block in atrial septal defect.

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This page is for informational purposes only and does not replace professional medical advice. Always consult your cardiologist or healthcare provider if you or your child are experiencing symptoms of a heart condition.

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