Athletes and Atrial Septal Defect (ASD)

 

Sometimes, congenital heart defects manifest for the first time in adulthood.  One such defect is the atrial septal defect (ASD), a “hole” between the upper chambers of the heart, the left atrium and right atrium.

There are 3 major types of ASD:  the secundum ASD, the primum ASD, and the sinus venosus ASD.  Each has distinguishing anatomical features, but today, for the most part, we’ll consider them as group.

We won’t consider another type of “hole” between the upper chambers of the heart, the patent foramen ovale (PFO).  In fetal life, the foramen ovale is a small hole which can persist after birth.  A PFO is usually small and ordinarily does not pose risk to the patient or athlete.

How is an ASD Discovered?

In adulthood, an ASD is often discovered incidentally during a diagnostic test such as an echocardiogram.  Adults can have no symptoms and be unaware of the defect.  If there are symptoms, an ASD can produce fatigue, arrhythmias, heart failure, or stroke.  An echocardiogram can delineate the exact type of ASD and also screen for any other types of structural heart disease which may be present.

A little bit of an aside for perspective….

In large-scale screening of school-aged athletes with echocardiograms, approximately 2% of individuals are found to have a structural heart problem.  Approximately one third of those defects are ASDs.

What are the Consequences of an ASD?

If the ASD is large enough (approxim. 1.0 cm or more), blood will flow through the defect in a left-to-right direction.  This results in extra blood in the right side of the heart and extra blood pumped to the lungs.  We can quantify the amount of extra blood flow to the lungs as a shunt fraction, or Qp:Qs ratio.  We say that the shunt is significant if the Qp:Qs ratio is greater than 1.5.  This indicates that the blood flow to the lungs is 50% greater than normal.

If left untreated, the extra blood flow through an ASD can lead to enlargement of the right atrium and ventricle and irreversible changes to the pulmonary arteries that results in pulmonary hypertension.

Athletes should be aware that a large ASD may result in decreased exercise capacity.

Closure of ASD

We generally recommend closure of an ASD if:

1.  The shunt fraction is >1.5.
2.  There is evidence of enlargement or failure of the right heart chambers.

Many secundum ASDs can be closed with devices that are deployed by catheters threaded to the heart through the body’s blood vessels.  We call this procedure a percutaneous device closure.  This procedure is generally performed by a cardiologist and involves the procedure followed by a short hospital stay.

Ostium secundum and sinus venosus ASDs require conventional heart surgery for closure.  These procedures are performed by a cardiac surgeon.  Healthy patients usually require a short hospital stay after the operation.

The peri-procedural risk of these procedures is very low.

How quickly an athlete may return to their sports will depend upon the particular method of closure and also upon the demands of an athlete’s sport.  This issue should be part of a discussion with the doctor before the procedure.

Recommendations for Athletes

The Congenital Heart Disease Task Force for the 36th Bethesda Conference on Eligibility Recommendations for Competitive Athletes with Cardiovascular Abnormalities made several recommendations for athletes with ASD:

1.  Those with a small ASD, normal right heart volume, and no pulmonary hypertension can participate fully.

2.  Those with a large ASD and no pulmonary hypertension can participate fully.

3.  Those with an ASD and mild pulmonary hypertension can participate in low-intensity sports.  Any athlete with ASD and associated cyanosis and large right-to-left shunt cannot participate in competitive sports.

4.  After a satisfactory recovery, athletes can participate fully after ASD repair (device closure or surgical) after a period of 3-6 months.

5.  After ASD closure, if an athlete has pulmonary hypertension, arrhythmias, heart block, or impaired heart function, there must be an individualized approach to the issued of continued participation.

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Comments

  1. says

    As an athlete who had a very large ASD that caused an atrial septal aneurysm, and was playing college soccer on scholarship WITH that ASD (unknowingly), it shows anyone can have a heart defect as such. I had a massive R to L shunt (Actually it went both ways), and associated cyanosis as you mentioned. I also had pretty serious shortness of breath, pre-syncopal, and syncopal episodes, all of which I attributed to being “out of shape,” or “asthma.” In fact, I was (am), in incredible shape, and the harder I pushed myself, the worse the issues got. ALL athletes need to get thorough heart screenings! I cannot stress this enough. No one is immune to these issues…thanks for posting this!

    • Kristen says

      Hi! I was recently diagnosed with ASD and am a college soccer player as well! I’m actually doing a project on ASD and was wondering if you would be willing to be interviewed via email over what it was like to be an athlete with ASD? Please respond to this post if you are and I will provide my email. Thanks!

  2. Larisa says

    I have a very small ASD (I don’t know the Qp:Qs ratio). I went through a screening and the cardiologist said that it’s so small that I didn’t need the surgery. However, when I do heavy cardio, or when climbing high peaks (above 13k feet) my heart definitely feels like it’s working hard. It feels like its trying to do fewer, harder pumps. It’s pretty uncomfortable. Also, above 13K I can only walk about ten feet before needing a rest. This is unusual since I’m very fit. I am athletic and do cardio 4-5 days a week. I’m planning a trip to Nepal in two years where I’ll be climbing above 17K. Though it’s small, I feel the effects. Should I still get the surgery? Or just grin and bear these effects?

    • Larry says

      Thanks for sharing your story, Larisa. The trip to Nepal sounds awesome.

      As you read in my post, very small ASD’s without significant shunt, are not generally closed. It’s always worth having a discussion with your doctor(s) when you think there are extenuating circumstances, though. And it might even be worth a 2nd opinion to give you peace of mind, regardless of what the first recommendation might be. There are sometimes legitimate differences of opinion.

      • Tracey Daxton says

        Hi, I’ve been diagnosed with a leaking ASD and am awaiting surgery, I have recently started getting palpitations and find it hard sometimes to take a deep breath while resting. I do also get breathless if I get up and move quickly. I’ve recently tried to join a gym to get fitter and I love swimming, but the ” cardio consultant” at the gym seems to think I shouldn’t swim at all and may not be able to exercise, is this correct? I’m a 46 year old woman.

        • Larry Creswell, MD says

          I don’t know enough about your particular situation to offer specific advice.

          My general advice is….get the heart situation sorted out and treated….and THEN resume exercise.

  3. aduncan says

    I recently had open heart surgery i had endocarditis complicated by a previous graft and artificial aortic valve surgery from 3 years ago so I got human tissue to replace graft and valve had been doing great and started having low heart rate in the 40 to58 range also had low blood pressures ex 83/43 I have been taken off of bp meds metopropal a recent echo shows an astral septal anuryssm could these be related to recently being diagnosed with a total heart block my doctors are great and on top of this but I am curious about whether these could be related

    • Larry Creswell, MD says

      I obviously don’t know enough about your particular situation to comment specifically.

      For you and others who may be reading here, complete heart block (CHB) occurs when electrical signals in the upper (atrial) chambers of the heart can’t or don’t reach the pumping chambers (the ventricles) like they normally should. Often in that situation, the ventricles generate their own electrical activity, usually with a rather slow heart rate.

      Complete heart block can be inherited or acquired. Acquired causes of CHB include infection, damage from too little blood supply, or from manipulation during surgery.

      Atrial septal aneurysm is an outpouching of thin, often wispy muscle tissue from the atrial septum, the wall between the 2 upper chambers. Sometimes, this is associated with a “hole,” or atrial septal defect (ASD) as well. What, if anything, should be done about atrial septal aneurysm would depend upon what else was going n with the heart.

  4. egb says

    I have run cross country and swum competitvely throughout high school, and have always been in great shape. However, I struggle with the last 25-50% of nearly every race I participate in, and especially hills when running. My training load should well prepare me for hills and endurance races, and those who train at an equal or lesser volume often outperform me during these final moments of races, both swimming and running. Like a previous commenter, I attributed it to being out of shape, although I’m pretty sure that’s not the case. What initiated my research of heart conditions and the ASD was a comment by my cross country coach. Apparently, my lips turn blue after particularly intense workouts. I had no idea, and would like to know whether this points to an ASD. A relatively close family member who was a high level cyclist, as it turned out, had an undiagnosed ASD that was finally treated at age 30 or so. My question is, does this conclusively point to an ASD and should I get an echocardiogram?

    • Larry Creswell, MD says

      It’s unusual for ASD to be associated with cyanosis (blue lips), but it can occur. In most cases, blood flows through an a ASD from the left TO the right side of the heart. Occasionally blood flows through an ASD in the opposite direction, from right to left….and that situation can result in cyanosis.

      ASD doesn’t ordinarily produce a murmur, so it takes an echocardiogram (ultrasound) to determine if you have one.

      There are many possible causes of cyanosis, some having nothing to do with the heart.

  5. Kristi says

    I was recently told I had an atrial septal aneurysm and SVT but the cardiologist said they couldn’t tell from the echocardiogram if I had an ASD and did not recommend further testing because I was asymptomatic. In hindsight, I’ve been thinking these heart problems may be behind my inability to improve my running or swimming speed. Do you think this is possible? I don’t expect to win any marathons but would like to know if these conditions are prohibiting me from improving my cardio fitness? I hate to compare myself with others but have an acquaintance who is about 50lbs overweight and can run a 5k faster than I. Any thoughts would be appreciated!

    • Larry Creswell, MD says

      Good questions, Kristi.

      Ordinarily a small ASD or PFO that was too small to visualize on an echocardiogram would not be significant to an endurance athlete, I wouldn’t think.

      SVT, on the other hand, an arrhythmia involving the upper chamber(s) of the heart, could certainly have an influence on performance.

      These issues would be worth discussion with your doctors, for sure.

      Larry

    • Larisa says

      Hi Kristi,
      I completely understand how you feel. I’m a very fit individual, but my entire life people around me have been able to gain cardio fitness more quickly than I. I also have ASD, but like you, doctors said there would be no point in fixing it since I’m asymptomatic. I’m thinking of going to another doctor for a second opinion because last summer when I was climbing a 14K mountain, I had a really hard time keeping up with my husband, and at the time, he never worked out while I was working out every day! We’re planning a through hike of the Himalayas in a couple of years, and I want to be able to enjoy myself, not drag. Best of luck. 🙂

      • Finn says

        Hi, i’m a triathlete, run marathons, do long distance skiing and so on. I did also mountain guiding in africa. I have always had easily symptoms on high altitude. They start already quite early. The main problem is that i’m feeling like falling asleep while walking. The previous trek to my Kilimanjaro I made it to the top but then fell unconscience. I Was brought a kilometre down and I woke up after 8 hours at another camp.
        Now in february 2016 a had a stroke. I recovered fully but I’ll be on mediaction the rest on my life. In examination they found a small asd which might be the cause of the attack. The asd will be Cloverfield soon.
        I have wondered while my marathon result is not improving. The time has decreased onko for six minutes during the Past ten years eventhough I have had coutches and I have trained systematically. So I Think the asd is the reason – the side is smaller than a 1cm… The doctor decided to close it because of the stroke and my active participation in competitive sports.
        I live in Finland…

        • Larry Creswell, MD says

          Finn asks about the consequences of ASD.

          In addition to whatever risk of stroke, there can certainly be a decrement in performance if the ASD is large enough (and there is a lot of blood flow through the defect).

  6. Kristian says

    Thank you for writing about this subject.
    I had a PFO closure only five days ago. The hole was 1 cm and they used the HELEX device. The device was very soft and made of gore-tex. The procedure went well and I am feeling good 🙂

    I am a triathlete and train for long distances. I am really looking forward to start training again. But I am not sure if I can just start training the many hours I am used to or if I should cut down and/or perhaps only train with low intensity? I am worried if the training can cause the device to move out of place? And what about the tissue that will cover the device over time. Can training have a negative effect on the growth of this tissue? (I was told it would take approximately 6 months before the device is covered in “tissue”)

    Given the type of sport (endurance/no contact) – do you think I can start training again (of course listening to my body), or should I take other special precautions?

    • Larry Creswell, MD says

      Kristian,

      Thanks for sharing your story. Best to follow the advice of your doctor(s) who will be in the best position to know what’s best for you given your specific details.

      Certainly, many endurance athletes are back to doing all of their activities after PFO device closure. Dislodgement of the device is rare, but may occur. I don’t know that such cases are related specifically to activity, though. You’re also right about “tissue ingrowth.” With time, the exposed surfaces of the device will be covered with fibrous or endothelial tissue. Again, I don’t know why that process would be impaired with activity. It might be impaired with medications such as NSAID’s, but that’s just a quick thought, off the top of my head.

      Good luck with getting back to triathlon.

  7. Siva says

    Hi,

    I underwent a ASD closure more than year ago. Recently I starting walking long distances and once I walked 18 KMs in a stretch. Many people say that it is not good to walk such a distance due to the fact that I have underwent a surgery. I did not feel any unusual heart rate when I walked. I restricted my activities the later day after the walk and also took a days rest. Can I do such walks once a week or should I limit myself to shorter distances.

    Thanks
    Siva

    • Larry Creswell, MD says

      Most people, athletes included, can return to exercise after ASD closure–whether it’s done by traditional operation or by catheter closure technique. Your doctor should be able to provide advice about how quickly to return, given your particular circumstances.

      Some athlete patients who need ASD closure may have additional cardiac problems that must be considered as well when making decisions about exercise.

  8. Evan says

    I am a professional mountain bike racer for 10 years. About five years ago after an overload training interval of 10 days I became very fatigued and have never been able to do back days of training or racing without debilitating fatigue. At aerobic HR 155bpm my cardiac output no longer increases although HR rate does. I get extreme hypoxic symptoms in my lower extremities at these higher HR while my breathing stays aerobic (30/min). I have suspected a heart defect or injury of some kind since I was at a world class level and now in a constant decline no matter what training or rest I do. My latest echo shows a small ASD at rest (38bpm). Is there any evidence that an ASD may dialate or worsen significantly at higher HR/pressure? Is there a way to test this? I have atrial enlargement but DRs just say that is because I am an athlete. Do ASDs cause persistent fatigue, sleep disruptions, severe cold/numbness and or pain in extremities? Are there any docs or studies regarding ASD manifestations in endurance athletes?

    • Larry Creswell, MD says

      No particular studies or reading to point you to. Appreciate that you found my blog post.

      It is true that the amount of blood flow through the ASD, as well as its direction, will influence any symptoms….and the amount of blood glow may depend on the exertion level.

      It would be worth discussing your symptoms with your doctor. In particular, ask whether increased blood flow through the ASD with exercise might account for any symptoms.

  9. Kelly says

    Glad I ran across this article! I am 33, active and athletic, and suddenly had a small stroke last December. Three days ago I had a Gore-Helex occluder placed in my heart to cover a 14 mm hole–now I’m glad I had the stroke or I would never have known!

    Other than a little soreness at the cath site, I actually feel better than I have in years. I didn’t realize I was operating under 100%, but evidently I was! It’s hard to take it easy and recover when you feel so good, but I’m trying to be good.

    I read in another article that lifting weights isn’t recommended for ASD patients. Is this true, even after closure? I do a lot of HIIT training and weight lifting, and I know it will be a while before I’m allowed back to the intensity level I was at, but hopefully it’s not forever, right?

    I’m interested to see how much better my cardio tolerance will be once I can work out again. I’ve always felt that for as much as I exercise, I should be in better shape!

    • Larry Creswell, MD says

      Worth having a discussion with your doctor(s) about activity restrictions. There may be different restrictions for the short term (during the healing process) and for the long term.

  10. says

    I fill up my asd in 2002. Now I have svt after two or three months.but normally it stops by 15-20 minutes.if I am having a cold glass water.can I go for operate. Means rf ablation

  11. amy says

    Wow this was an insightful article.. it’s very frustrating as I went from running a half marathon 2 years ago, to not being able to walk on a treadmill in the past year without getting short of breath immediately (then I start hyperventilating). I have a small ASD and recently got an echocardiogram. My cardiologist said it was okay for me to exercise and it shouldn’t be causing shortness of breath. .. Would it be beneficial for me to get a stress test to see why I am getting short of breath? I know it could be anxiety…. I’m hoping to be able to exercise again with confidence.

    June 2014 Echo – “. Normal left ventricular wall thickness, chamber size and systolic function. Estimated
    ejection fraction 64%. Normal diastolic function. Normal biatrial size. Small secundum
    atrial septal defect with left to right negative contrast on aggitated saline study.
    Calculated Qp/Qs ratio 1.5:1 Negative aggitated saline study for right-to-left shunting.
    Right ventricular size appears to be at upper limits of normal.
    . Normal valvular morphologies without significant flow abnormalities. Normal aortic root
    and aortic arch dimensions.
    . Normal estimated right-sided pressures. Normal sized IVC collapsing with inspiration.
    No prior study.
    No cardiology follow up visit scheduled. “

    • Larry Creswell, MD says

      Shortness of breath should always get sorted out.

      It’s usually possible with echocardiogram to be sure that the ASD repair is doing okay (or not).

  12. Kristen says

    I am a college soccer player recently diagnosed with both ASD and neurocardiogenic syncope. I am going to the Cleveland Heart Clinic next week and am unsure what to expect. Now that I know about my conditions, it seems to make sense why even after getting a good night sleep, I am always feeling tired. I also seem to notice my heart beating much faster; it seems like after my diagnosis, I am noticing many signs I thought were normal my entire life. Its very confusing to think about. What I am mostly curious about however, is if both of these conditions could be related?

    • Larry Creswell, MD says

      Those are all good questions for your doctors at Cleveland Clinic.

      Sometimes, it’s easy to think back and wonder about symptoms that might have gone unrecognized.

  13. Michael says

    Dr.
    Just curious, I had the PFO closure done two weeks ago at NY Presbyterian Hospital. I am a 50 year old, extremely active, triathlete, boxer, and personal trainer. My doctor says I can return to training now. I have never felt better, I can finally breath, and am able to sleep through the night (something I don’t ever remember doing.) I just want to be cautious since I have always trained very hard, almost every day.
    Thanks.

    • Kelly says

      I’m not the doctor, but I had the same question. I had the transcath closure of a moderately large ASD last August (with a gore-helex septal occluder), and I think each doctor’s opinion on training is a little different. My doctor told me to keep my HR under 140 for three months and only lift weights at 70% of my max. Once everything looked fine on the echo at 3 months, I was cleared to go “do burpees and sprints to my heart’s content.” It was hell not going hard for those three months when I felt so much better, but now I’m training harder and lifting heavier than I was ever able to before.

  14. Steve says

    Apparently I have a ASD as well. Right to left shunting during valsalva manoeuvre. My questing is – is it ok to do extreme sports like Bungee Jumping. I remember doing this 20 years ago and all my eyes became blood shot where everyone else was fine.

    • Larry Creswell, MD says

      You’re brave!

      Maybe another reader can chime in. Sadly, I don’t know anything about the effects of bungee jumping on the heart.

  15. Meghan says

    I am so happy I found this site! I’ve been having heart palpitations for about two months. I brought it up with my GP and since my mother had mitrovalve prolapse she sent me for and ECHO. Well sure enough it came back that I have a secundun atrial defect. However, I’m an avid runner and have two half marathons within a week of each other at the end of the month. I don’t get my first appt with a cardiologist until the week after those races. My doctor recommended that it was an “urgent” need to get in with the cardiologist, but I would love to hear your thoughts on whether you think I should continue on with the races. Palpitations are still present and seem to be increasing a bit as I hit my training peak. I will begin to taper in a few weeks. Thanks so much!!!

  16. Maddy says

    Like everyone else I’m so happy to have found this article/ blog!

    I’m 20 years old and had my ASD closure in December 2014 (using an Amplatzer device). When I went for my check up echo in January everything was going well and all blood flow had ceased. I’m a bit of a gym junkie, doing cardio 4 times a week and weight training 4 times also. I was told to wait at least 3 months before going back to lifting and that the tissue would be completely healed after 6 months, meaning I could resume all activity like a normal person. Are you able to tell me what kind of effects heavy lifting would have on the closure after 4 months/ what restrictions I should place on myself?

    I was also told not to have any dental surgery without antibiotics for 1 year post op. My only concern is that I fainted before my surgery (how I found out about the ASD) cracking my front tooth, which was filled but has started to die and I do need a root canal. Do you think there is a risk of endocarditis if I leave the tooth as is until I see my specialist again in June, or should I be concerned? I did also receive a dose of antibiotics 1 month after the tooth fracture to ensure there was no infection, which was about 2 months before the heart surgery. I don’t think that I have any symptoms of endocarditis but I’m unsure of how long onset of symptoms/ main symptoms are.

    I should also note that I’m on Clopidogrel and Asprin for 6 months. Thanks for your advice!

    • Larry Creswell, MD says

      Thanks for sharing the story of your ASD closure.

      Most athlete patients can return to their sports after they’ve healed up, so long as there are no other heart problems that must be considered. Ask your doctor what he/she thinks best.

      Your doctor should also have specific advice about when it’s safe to have dental work done. For some forms of dental work, it’s necessary to stop taking medications like aspirin and clopidogrel.

      • Maddy says

        Okay great, thanks for that.

        One last question, would those two medications have an impact on heart rate while exercising? I find sometimes my heart rate increases quickly and is quite high around 145 for moderate cardio. I don’t feel lightheaded or anything, but should this be of concern?

  17. SANJAY BAWA says

    MY DAUGHTER IS AN 26 YRS OLD ARMY OFFICER AND HAS BEEN NOW DETECTED WITH ASD SIZE OF 2.6 CMS
    SHE WAS IN COLLEGE BASKET BALL AND HAND BALL TEAM AND WAS GRADED AS EXCELLENT IN HER PHYSICALS DURING ARMY TRAING I AM SURPRISED WHY IT WAS NOT DETECTED EARLIER AND HOW SHE SURVIVED THE ARMY TRAINING AND IS GOING TO BE TREATED BY USING THE ASD CLOSING DEVICE WHAT ARE CHANCES OF LEADING A VERY ACTIVE LIFE NOW AND SUBSEQUENT ISSUE S OF MARRIAGE AND PREGNANCY WE ARE WORRIED SANJAY

    • Larry Creswell, MD says

      Most ASD’s are discovered in childhood, but there are certainly many cases of this diagnosis being made in a patient’s twenties.

      ASD repair, either by catheter techniques or with surgery, is nearly always successful and can be accomplished at little risk. After repair, most patients can return to any activities they’d like….including marriage and pregnancy.

  18. Chris Solomon says

    Was recent diagnosed with humongous atrial septal aneurysm with large atrial septal defect (left-to-right shunt by color Doppler) located at the upper portion of the inter atrial septum. What’s concerning is I had several heart test in 2010 which I thought would have showed abnormalities as I was being tested for blockage and heart dease. I have PTSD with pre hypertension and spikes during my PTSD attaches is it possible for hypertension to cause an aneurysm or cause the shunting

    • Larry Creswell, MD says

      An atrial septal defect (ASD) is usually a congenital problem….affected individuals are born with the problem. Most ASD patients are identified in childhood, but some escape identification until adulthood, where it is discovered because of testing such as echocardiogram.

      The “aneurysm” involved with the ASD is not caused because of high blood pressure.

  19. Alexandra says

    Hi ..my 14 year old daughter was diagnosed with a 9 mm ASD2.
    She has been an active soccer and rugby player all her life. The cardiologist said she can continue sports but we need to keep checking on her every year.
    she gets dizzy and cold sweato when she plays.
    I am not sure if we should let her continue with her beloved sports…please advise.

    • Larry Creswell, MD says

      From afar, I don’t have sufficient information to provide advice about your daughter and continued participation.

      Symptoms like dizziness and cold sweats deserve attention. You should take up these issues with your daughter’s doctor(s).

  20. RJ says

    Hi. Great site.

    So I recently had a pfo closure through the artery. Right now it’s week three post surgery. I’m finding that I can take more air into my lungs. Do you think this is just in my head? I hope not. I like the idea that my body is now getting the right levels of oxygen it needs. In fact I feel like I’ve gained a few IQ points as I feel I’m also thinking better. Can a pfo closure have this kind of effect. I mean if my body adapted to 30% less oxygen and suddenly it’s gone up to a 100% have I had some sort Captain America transformation?

    • RJ says

      Oh. One question. Would it be safe for me to start light jogging this week? Dr said after four weeks I can go back to regular activity so I’m sure light jogging at the end of week three should be okay?? I’m more curious than anything to test this extra oxygen capacity to see if I can run laps around the block without getting tired…like Captain America.

  21. Sharon says

    Hi, I have Forame Ovale is that the same as ASD?
    What i’m trying to figure out is if i can train with HIIT high intensity interval training and if i can what rate should my heart stay at.
    Thankyou.

    • Larry Creswell, MD says

      Everybody has a foramen ovale, an opening in the inter-atrial septum, during in ute to development. It usually closes. If it does not close, we say there is a patent foramen ovale (PFO).

      If a PFO is large, significant amounts of blood glow may pass through the opening, just as in ASD.

      Whether or not a PFO should be closed is an issue to take up with your doctor(s).

  22. Rose says

    Hello, I’m 51 & & have been suffering Dreadful shortness of breath & fatigue for past 2 /2 yrs., transthorasic echo. & Doppler exam. Indications PFO. Conclusions. 1. Hypermobile inter-atrial septum with probable shunt. Findings. ECG. Sinus. Stage 1diastolic dysfunction.
    Trivial mitral regurgitation.
    Right ventricular systolic pressure consistent with Mild Pulmonary Hypertension. Mild Tricuspid regurgitation.
    IVC. Normal inferior RNA cava appearance & respiratory collapse. Normal pulmonary artsy size. Pulmonary ratio. 1.9 . Very worried could this be contributing to SOB?
    Please Reply!!!!!

    • Larry Creswell, MD says

      Lot’s to sort through here. Too much from afar, really.

      Holes in the heart (eg, septal defects) with blood glow through them….can sometimes cause shortness of breath.

  23. Lois says

    I had my ASD closures in 2013 and my shunt put in. I had my year check up with my cardiologist last year and all is healed and looking well. I was playing up until that point a full contact sport but she advised me to quit saying that consistent hits to the chest could dislodge the device. I am following her advice but I miss playing the sport I once played and wondered if you had any further comments about playing contact sports post ASD closure. I would also like to add that a different cardiologist told me that I was able to play before I saw her last year so am confused. Thanks.

    • Larry Creswell, MD says

      From the newly published 2015 ACC guidelines for young competitive athletes, regarding ASD closure:

      “Three to 6 months after operation or intervention, athletes without pulmonary hypertension, myocardial dysfunction, or arrhythmias may participate in all sports.”

      Your doctor(s) would be in the best position to know if that describes your situation correctly.

  24. Katie Ronald says

    I am a 33 year old athlete. I have been active and played sports all my life. I ran 3 half-marathons last year and did my first sprint triathalon this Spring. I started to have dizziness, shortness of breath, fatigue and nausea with multiple PVCs in the Spring. After a battering of tests, I was found to have a moderate ASD. My symptoms, especially the dizziness and shortness of breath with exercise, increased up to my surgery a few weeks ago. My dizziness is gone since the surgery, but now I am having mild shortness of breath with minimal activity, like doing errands around the house, that comes and goes. Some days are worse than others. I have had 3 or 4 EKGs with no major arrythmias found, an Echo 1 week out that revealed my device was still in place, and a CT of the chest which ruled out a pulmonary embolism. So far no answers to why I get short of breath intermittnently. Walking with an O2 sat monitor in the office my O2 sats dropped into the 80s with my shortness of breath. A second trip around the office 20 minutes later did not lead to reproducible results. (This inconsistent O2 drop has happened twice with two different visits.) I am frustrated as my shortness of breath is worse after surgery, although my dizziness is now gone which is a plus. All 3 of my cardiologists (surgeon, EP, and primary) do not have answers at this point. Anyone else have worsening of shortness of breath after surgery like this? Did it improve over time? Can you develop pulmonary hypertension after surgery when it was not present prior to surgery? I see my cardiologist again next week, so hoping he maybe has an answer or more tests to run? I am getting a bit tired of all the tests. Any insight would be greatly appreciated.

    • Larry Creswell, MD says

      Thanks for sharing your story. Perhaps others will chime in with their own experiences.

      I think it would be unusual to develop new pulmonary hypertension early after ASD closure.

    • Maddy says

      Hi Katie,

      I had a similar experience after my ASD closure which was a year ago in December. I would get dizzy and have shortness of breath before the surgery and I found that afterwards It had worsened. About 1 month after my surgery I was back in hospital with severe palpitations and a second degree AV Block. I was told that the reason I was experiencing all of this was because my body was getting used to the device as its a foreign object and that my body is under stress, which had increased because I was worried about the device and what was happening to me at the time.

      I waited another month before I went back to exercising and I found that by only sticking to cardio for the first 4 months, although gradually easing into it, improved my shortness of breath and dizziness significantly. I also stopped drinking alcohol in that time and focused on getting enough sleep each night. 1 year on and my cardiovascular fitness and strength is far beyond what it was before I even knew I had the ASD.

      I know it’s a stressful time and it’s frustrating not being able to jump back into your normal routine, although everyone is different and will react to the device differently. If your doctors can’t find a medical explaination, maybe you just need more rest and to de-stress. It certainly worked for me and I’m only 20 🙂

      Hope you find the answers you’re looking for soon.

  25. rasi says

    My daughter 12 yrs having asd of .5””m m Want to know wether it need to close ,can send her for swimming or games.

    • Larry Creswell, MD says

      ASD’s do come in various sizes, but ordinarily the important consideration is how much blood is flowing through the ASD. Ordinarily, an echocardiogram is used to sort this out.

  26. Yury says

    Hi,

    I am 30 year old male, hitting gym 4 times a week for 1.5 hours for the last 5 years. Competitive swimmer in my childhood – teens.

    I started experience dizziness a year and a half ago. Went to multiple doctors, all kinds, from eye surgeons to balance doctors. Done 2 EKG’s, 2 chest X-rays, wore a heart beat monitor and finally was sent to Echo. Echo revealed a small secundum atrial septal defect. I found out about it while visiting my GD for unrelated skin rash. He casually told me that Echo discovered a small ASD. No indication on how small it is. After the diagnosis, I started experiencing very uncomfortable chest sensations. Not exactly pain, but tightness that travels across the chest depending on the time. Sometimes it get worse when I take a deep breath. I don’t know if this is due to anxiety or my heart started acting up. I had the similar problems twice before. Each time I went to doctor, each time he sent me to EKG + Chest X ray, which showed nothing.

    I am depressed and can’t live my life normally after the diagnosis. I was sent to heart surgeon who informed me that he doesn’t deal with congenial heart defects and I have to seek a different doctor. Don’t know how much time will go by before I can talk to a specialist.

    Can I continue working out with a small asd? Do I need it to get repaired? It will drive me crazy if I stop lifting weights.

    Thanks

    • Larry Creswell, MD says

      It is generally safe for athletes with a small (untreated) ASD to participate in sports if:
      1. The size/function of the right side of the heart are normal,
      2. The pressure in the pulmonary artery is normal,
      3. There are no other heart problems.

      The decision about whether to repair an ASD usually hinges on how much blood flow (“shunt”) there is through the ASD.

      Ordinarily, the echocardiogram can sort this all out.

  27. Sam says

    Yury,
    You’re not alone. I’m a fit 32 yo female – was diagnosed 2 years ago with a small ASD (when I started getting palpitations)…after I started getting on & off dizziness, SOB and chest discomfort. My cardiologist said the defect doesnt need to be fixed right now…so I’m continuing to lift weights and working out regularly. It’s not easy living with these symptoms. But try to hang in there and get a cardioligist’s opinion! All the best. And thank you Dr. Creswell for such a helpful website!

    • Yury says

      Hey Sam. Thank you for your kind words. I actually went to a heart surgeon for a comprehensive opinion and he requested another ultrasound, this time with the bubble test, as he said sometimes small ASDs are misdiagnosed. We’ll see. I feel somewhat better now. I think a lot of symptoms manifest themselves due to mental strain any sort of diagnosis puts on the person.

      Thank you.

  28. Christine says

    I was dx in 2013 with Atrial Septal Aneurysm by cardiac scan. At the time was told not to worry … at the time I was also dx with exercise induced HTN started on lisinpril and BP was great but developed cough and taken off no new BP meds prescribed 6 months later ……. Then in 2015 I had a stent after 90% blockage LAD was found…. given metroprol ER 25 mg daily …. one year later still have Exercised induced HTN even on medication … now increased to 2x day am and pm 25 mg metropol. Should I be concerned that no one is concerned about the Atrial Septal Aneurysm , it is never even mentioned
    Thanks

  29. Mark Cady, MD says

    My son is 20 y/o. He is crew captain at his university. He trains on the erg and in the water 6 days a week. A year ago he noticed his hands and feet turning blue with with maximal exertion. In the last few weeks this cyanosis goes half way up his arms and legs and involves his whole face. He reports substantial chest pressure at the same time.

    My son is otherwise very fit and healthy. He is not a heavy drinker and does not abuse substances. There is no family history of cardiopumonary disease.

    His symptoms make me think of exercise induced shunting and cyanosis. Seems odd to arise out of the blue. I am having him see a cardiologist as soon as possible.

    Any thought to a possible diagnosis?

    • Larry Creswell, MD says

      For the readers here, cyanosis is the medical term used for the bluish discoloration of the skin that results from too little oxygen in the blood.

      As Dr. Cady points out, one potential cause of cyanosis can be an inherited defect in the heart which allows de-oxygenated blood to be pumped to the body. The typical examples are “holes” between the chambers of the heart such as atrial septal defect (ASD) or ventricular septal defect (VSD). There are other, less common, defects that can produce the abnormal shunting of blood.

      The starting point for diagnosis starts with the physical exam, looking and listening for evidence of the various conditions that can produce the shunt. Often, the echocardiogram (ultrasound) is used to identify or rule out the various possibilities.m if doubt remains after the echocardiogram, cardiac MRI or CT scan can be used to study the anatomy of the heart (and the large arteries/veins that carry blood from/to the heart).

      Good luck with the upcoming cardiology visit. If you get the chance, please check back and let us know how things turn out with your son’s evaluation.

  30. Michelle says

    Hi, I am 18 years old, I was diagnosed with infective endocarditis last year and was treated with IV antibiotics. The doctors suggested closing my congenital VSD and ASD and I underwent an open heart surgery in January. I’ve always been an active person and love running, but I’m not sure when I should start running again, the doctors said it should be fine but I’m afraid of the jumping impact. Even when running across the road my heart feels weird, I don’t know if it’s just psychological. Can you give me some advice? Thank you!

    • Larry Creswell, MD says

      Many athlete patients note some difficulties and apprehension getting back to exercise (or training) after operation.

      Most patients with corrected ASD and/or VSD can once again participate fully in their sports.

      For most athletes, it is wise to check I. With your doctor(s) after resuming exercise to talk about your experience and get any additional advice.

  31. Akhilesh says

    Hii all
    I was daignose with ASD during annual medical. I m defence person. A civil dr told me that i have 11 mm ASD during TEE check up but in millitary hospital dr told that it is 15 mm after TEE. I asked him why size is differ, he replied that it differ with angle of approaching.
    Now i wnt to ask is it happen that size differ with angle of approaching

    Second thing on 1 4 mar 16 i have gone under cather treatment where the doc told that ASD is very small it is not 15 or 11 mm, it is less than measured size even there was aneurysam than dr took 22 mm length of one side so that aneurysam can also resolved and 10 mm lenghth of closure device with another side
    Now they took echo view and found with no L to R without aneurysam.
    How many time taken by tissue to fully cover the device
    Plz reply i m worried to know and what type of restriction during this cover period like walking, driving ,eating related

    • Larry Creswell, MD says

      There can be small differences in the measured size of an ASD when measurements are made with different machines, on different days, with different people doing the measuring. What’s most important is the amount of blood flow through the ASD. We sometimes call that the “shunt fraction.”

      You also mention “aneurysm.” There can be so-called aneurysm of the inter-atrial septum, the wall between the upper chambers of the heart, where that wall is billowing, like a sail.

      You also ask about restriction to activities after a closure procedure. Most athletes can return to their sports after a successful percutaneous ASD closure once the tissues have had a chance to heal up.

      • Akhilesh says

        Thanks a lot sir
        Sir after ASD treatment, in my ECG it shows sinus arrhythmia which was not before ASD closure. Dr told its normal n it happens but i m little bit worry abt that, in the month of sep i’ll complete six mnth after this closure n again going for check up.
        Pls suggeste me anythng which i supposed to ask to Dr.
        Thank you

  32. Claire says

    Hi, I am 15 years old. I was diagnosed with 1cm of ASD(not sure which type) last winter. I am planning on getting my closure surgery this summer. I play tennis, and I was wondering if I will be able to continue playing tennis after about 2 months getting the surgery. Is it ok for me to keep playing tennis after the surgery? What do you suggest?

  33. Terry says

    Thanks for a great blog post. My question is fairly simple: Would the maximum heart rate be lower in athletes with an ASD or PFO? A trial runner, for example, that can run 13.1 events, yet never is able to get max HR over 150 bpm even with maximal exertion. The age of the runner is 50 y.o. A PFO is suspect due to migraines and a mother with PFO (diagnosed at 70 y.o.).

    Thanks for any insight into the heart rate. An echo will be done soon (some palpitations and a mild mitral valve murmur).

    • Larry Creswell, MD says

      I’m not sure there would be a consistent relationship between maximal HR and the presence (or absence) of an ASD or PFO.

      I would think that, in the case of a large ASD, there would be an artificially ELEVATED heart rate for any particular pace (since there would be additional shunting of blood through the ASD).

  34. Christopher Nickell says

    I am posting about an ASD closure for those 40-something athletes. I discovered the hole in my heart in 2008 after moving to Denver, Colorado and experiencing a change in altitude. Prior to that, for the first 34 years of my life, I just thought I was in worse shape than everyone else. I was always short of breath, had heart palpitations regularly but other than that, normal. In 2008, when we moved to Colorado, I went on my first hike as a new resident and thought my heart was going to explode. I chalked it up to altitude. Well, a few months later, I had an episode sitting on the couch where I thought I could be having a heart attack. At the University of Colorado, they discovered severe shunting and an Atrial Septal Defect. While under the care and progress of the doctors at U.C., we had to move for my job to Phoenix. I immediately got a cardiologist there who changed the diagnosis to a PFO (smaller hole) and did not recommend a procedure to close the PFO. I will never forget what he said…”think of your heart as an engine, sometimec engines just don’t run perfectly but they keep running just fine, it just might have a sputter”. He then handed me a psychological services pamphlet and implied I might need counseling for anxiety. I knew that he was completely wrong but didn’t pursue another opinion in Phoenix. My symptoms continued over the next two years, I had regular scary episodes where my wife would have to massage my chest lightly and give me aspirin to make it subside. After going through now a total of four years of wondering what was wrong, we moved for work again, this time to Utah. I got a new cardiologist who diagnosed me with a large PFO or a small ASD. I began to experience headaches, severe shortness of breath, multiple palpitations each day and my ability to workout was diminishing. He completed an internal echo and recommended that we close the hole with the Gore Helix Amplatzer II device. The bad news, my intense workouts would stop for a while. For the first month, nothing, for the next five months light cardio and no lifting over 25 lbs. On February 18, I was wheeled in and the procedure began. A short time later, I was back in my room with my wife. The cardiologist came in and said that it was a good thing we closed the hole, he could have driven a semi through it and he had to use the largest device made by Gore and it almost wasn’t enough. I am now at the six month mark. I am exercising regularly, still lifting light weights until I get further clearance. What I do not have is shortness of breath, I do not have headaches and have only had one “episode” since the closure. I am not as strong as I once was and my workouts have changed from mostly lifting to mostly light weights at a rapid pace and lots of reps. I still feel an occasional pull or tug in my chest and I believe that is the device simply present in my heart. Regardless of the scar tissue closing over it, it is still a metal frame the size of a half dollar in my chest, I am going to feel it. Had we not persistently continued to change cardiologist as we moved, I may have never had the surgery and discovered it was in fact, a large ASD. Who knows what that could have meant for me as a father of four and a happily married man. I missed most of the ski season last year, this year I am looking forward to skiing without panting and having to stop on every run to slow down my breathing. I encourage you to be persistent when you know your body, no one else knows it as well as you.

  35. J. Morgan says

    Hi, my daughter is a div.1 college soccer player. She collapsed with a seizure last February. Tests found nothing wrong neurologically, but found a large hole in her heart. They fixed the hole and found 3 smaller holes bunched together and fixed those as well. 4 days later she had another seizure. She has had 5 total, about 1 per month. Growing up she suffered sever pain in her extremities after games in cold weather. She also has a very slow heart rate and occasional heart block. 2 times the heart block was 3rd degree. Can this all be due to the ASD?
    Thank you!

    • Larry Creswell, MD says

      I’m not sure about your daughter’s exact situation, but yes, heart block problems can be present in patients with ASD.

  36. bev says

    Hello. My brother had ASD closure last May 2015. He wants to participate in swimming competition now in their school. Is it ok for him to do a competitive swimming now?

    • Larry Creswell, MD says

      Exercise and sports are usually safe, without restrictions, for patients with closed ASD (by whichever technique). Exceptions would be for those with other heart problems in addition.

  37. vijay Singh says

    Hi , I am 34 year old and a healthy person,going regular Gym and participate in sports. Recently in regular health checkup doctor find ostium secundum asd with 24 MM size. Does It require to close .And as you mentioned “If the ASD is large enough (approxim. 1.0 cm or more), blood will flow through the defect in a left-to-right direction” can it be safe without closing it.

    • Larry Creswell, MD says

      Closure is recommended for patients in whom the left-to-right shunt causes the right side of the heart to suffer. Usually echocardiogram can sort out this issue.

  38. Claire says

    What are some symptoms when your ASD closure goes wrong? I had my closure in July and I feel that tool that closed up the hole came off.

    • Larry Creswell, MD says

      I would think that your original symptoms (if any) would return. If there were no symptoms, then dislodgement of a closure device would only be discovered by some sort of imaging test, perhaps echocardiogram.

  39. BP says

    Hi, I am a 16 year old female hockey player and I am starting to wonder if I have ASD. I am in good shape and I always push myself as hard as I can go but I am really struggling, when I play I almost instantly get so tired that I feel as if I could fall asleep and my legs and hands feel really “heavy”( not due to poor nutrition). I do have asthma and I have always blamed it on that, but i’m starting to think asthma is not the culprit. I have done some research and I do have other symptoms such as my hands and feet swelling randomly and excessive sweating all the time. Also, my coaches always tell me my complexion looks awful during and after practice. Is this something I should look into? I’m kind of nervous to talk to my mom about this because I think she might think i’m being ridiculous.

    • Larry Creswell, MD says

      Many small ASD’s produce no symptoms at all. If there is a lot of (unwanted) blood flow through the ASD, The most common symptom is shortness of breath, particularly with exertion.

  40. Martin H says

    Thank you so much for the information on this page.

    I am a 25-year-old Olympic weightlifter who had a successful closure of my ASD two weeks ago. I was given instructions to not do any Olympic weightlifting until 3 months after the procedure. I really want to try to reduce muscle loss as much as possible. If any, what kind of lifting exercises can I do? Any barbell, dumbells exercises you can recommend? I was also told that I could do cardio, do you have any thoughts on high-intensity cardio workouts?

    Thank you 🙂

    • Larry Creswell, MD says

      We generally recommend holding off on exercise for a few weeks after ASD closure to let the device begin to heal into the surrounding heart muscle. Wouldn’t want to jeopardize a good result. I know it’s frustrating to wait, but….

  41. says

    Hi!

    I’m a 20 year old female who was recently diagnosed with an ASD, the right side of my heart is slightly enlarged and the doctors thinks that’s why I’m having severe symtoms, but that it will go back to normal size after my surgery, but the pressure in my lungs are normal. I will have my hole closed via catheter closure (the Amplatzer device) this February or maybe sooner if I’m lucky.
    I can’t wait til my surgery and to get this over with and start feeling better again and like myself. But now I’m a bit worried about my surgery, I wasn’t that worried before to be honest, but now I’ve read online that the device can move out of place and it could be very dangerous if that happens?? I was shocked after reading that, the doctors never told me anything about the device being able to move out of place..
    Maybe because it isn’t common that it happens? I feel very anxious about that right now, I thought I would have my surgery, revocer and then everything would be 100% normal again but now I feel like I will still be afraid post surgery.

    Do you have anything to say in that matter? 🙂

    • Larry Creswell, MD says

      Good luck with your upcoming procedure for ASD closure.

      Most patients can return to exercise without restrictions following ASD closure. Be sure to ask your doctor.

  42. Noushad says

    I have a new born boy of age 1 month. After ECG, we know that he has a small PFO type of ASD of 5 mm size with left to right shunt. Please tell me more about this disease and the treatment for it.

    Thanks

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