# Atrial septal defect

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- Sources: Atrial Septal Defect - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK535440/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class KD55.00 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care
- Verified date: 2026-08

## Verified against

- No dose - referral pathway, no medicine given in primary care

## Treatment metadata

- No drug therapy in primary care (Referral & Advice)

## Complete treatment card

```text
ATRIAL SEPTAL DEFECT
Sources: Atrial Septal Defect - StatPearls - NCBI Bookshelf -
         https://www.ncbi.nlm.nih.gov/books/NBK535440/ · ICPC-3 (WONCA International Classification
         of Primary Care, 3rd edition) class KD55.00 - condition scope only, no dose · No dose -
         referral pathway, no medicine given in primary care
Review status: REVIEWED against the source listed above  (2026-08)

IS IT THIS? - reference only, to read alongside your own examination
  SYMPTOMS - what the patient reports (5)
    - Often causes no symptoms at all, especially with small defects
    - Untreated large defects can cause reduced exercise tolerance, palpitations, and more frequent
      pneumonia  [palpitations]
    - Eisenmenger physiology brings chronic cyanosis, breathlessness on exertion, fainting and
      higher infection risk  [breathlessness · cyanosis · syncope]
    - Larger defects present with breathlessness, fatigue, poor exercise tolerance and palpitations
      [breathlessness · fatigue · palpitations]
    - A stroke or TIA, especially after a peripheral clot, should raise suspicion for an underlying
      ASD
  SIGNS - what you find (1)
    - A soft systolic ejection murmur at the pulmonic area with wide, fixed splitting of the second
      heart sound is characteristic  [heart murmur]
  TESTS (5)
    - Transthoracic echocardiogram is the gold-standard test, showing defect size, shunt direction,
      and pulmonary pressures
    - Transesophageal echo is better for detecting rarer atrial septal defects
    - Chest x-ray is less diagnostically useful but can show cardiomegaly and pulmonary artery
      enlargement over time
    - Exercise testing can assess whether shunt reversal responds to activity
    - Cardiac catheterization is not indicated in young patients with small, uncomplicated defects
  IF NOT THIS - what else fits (4)
    - Ventricular septal defect, a hole between the ventricles
    - Cyanotic congenital heart disease from a sinus venosus or coronary sinus defect
    - Total anomalous pulmonary venous return, where pulmonary veins drain abnormally
    - Other outflow tract anomalies: pulmonary stenosis, truncus arteriosus, or tricuspid atresia
  Source  StatPearls "Atrial Septal Defect" - disease-level clinical article
  Status  traced to the source above

1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)    [1st line]
   Adult    Atrial septal defect is usually picked up on a murmur or incidental echo; the GP refers
            to paediatric or adult congenital cardiology for confirmation and a decision on closure,
            with no primary-care drug treatment. - Refer, with advice
   Peds     Children follow the same pathway: recognise and refer. No primary-care medicine is
            implied.
   Source   No dose - referral pathway, no medicine given in primary care
   Why      Atrial septal defect is usually picked up on a murmur or incidental echo; the GP refers
            to paediatric or adult congenital cardiology for confirmation and a decision on closure,
            with no primary-care drug treatment.
   Caution  RED FLAG - Paradoxical embolism causing acute ischemic stroke: assess urgently and
            refer.
            Signs of heart failure or pulmonary hypertension (breathlessness, poor growth, cyanosis)
            need prompt cardiology assessment.
            No medicine is prescribed for this in primary care - this entry is for recognition and
            referral. Anything given is decided by the service it is referred to.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.
```

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