Atrial Septal Defect (ASD): The Silent Heart Hole That Often Goes Unnoticed

February 6, 2026

Atrial Septal Defect (ASD): The Silent Heart Hole That Often Goes Unnoticed

Verified By
KIMS-SUNSHINE
Specialist,
06 February, 2026

Atrial Septal Defect (ASD): The Silent Heart Hole That Often Goes Unnoticed

An atrial septal defect (ASD) is a common condition that affects millions of people worldwide. Studies show that ASD accounts for over 40% of all congenital heart defects in adults in the Indian subcontinent. The heart is divided into four chambers with a specialised septum or wall in between. When there is a hole in the septum or wall that separates the upper atria, it becomes a septal defect. Most individuals don’t really show symptoms until adulthood and even then, they may not require any specialised treatment. If you would like to talk to the best heart specialist in Hyderabad, walk in to KIMS Sunshine Hospital today!

Hole In The Heart Symptoms

Atrial septal defects are normally present from birth and most people don’t show overt symptoms until much later- and even then, it is only when there is intense activity involved, which may compromise how the heart or lungs have normally worked. Some of the symptoms you may notice include-

A heart murmur – but this is only heard when a doctor checks the heart with a stethoscope.
Breathlessness when you have performed some intense exercise.
Fatigue or tiredness is pretty common.
Palpitations of the heart are common too.
Heart rate is high or fast (tachycardia).
You may notice oedema or fluid accumulation in the extremities.
Blue coloured skin on the lips or fingertips is also observed at times, due to poor oxygenation.

Diagnosis of ASD

Diagnosis normally involves detailed imaging- to check how blood is flowing in various blood vessels and within the heart. So, some of the tests that you may be asked to get done include-

An EKG- To check for abnormal heart rhythm or changes in electrical activity.
A TTE- Transthoracic echocardiogram checks how blood flowing from the left to the right affects its activity overall. This technique can pinpoint any lung related hypertension too.
A chest x-ray is good to check for enlargement or hypertrophy- which is a compensatory side effect that can become problematic in the future. It can also check for the ASD itself.
A TEE- Transesophageal echocardiogram is done to check how the heat valves are functioning and to check for the size, location and shape of the ASD.
A cardiac CT or MRI is also pretty useful in some cases.

Other techniques may also be used, though sparingly.

Treatment for ASD

Very small defects or holes that are less than 5mm in diameter don’t require treatment, as it can close in a few years. But, if the hole has not closed and you have become symptomatic, it is best to get treated promptly. Treatment is recommended if your heart has enlarged or if there is more blood flowing through the septal defect itself. The ASD closure procedure is normally recommended in such cases- a device is used to plug the hole, or sutures are placed to sew it up. The approach used can be an open-heart surgery or it may be minimally invasive too, where a catheter is threaded up through a blood vessel and then the defect is sewed shut.

After the surgery, you will be on antibiotics and blood thinners for a few months.

Conclusion

Untreated atrial septal defect complications include heart enlargement- where the right side of the heart becomes larger in size. Heart rhythm gets affected too and this can lead to hypertension in the lungs. If blood flow is not properly restored, you are at higher risk of suffering from a stroke too. If you have learned that you have a hole in the heart, don’t worry too much. Instead, walk into our hospital for a consultation, as we have the best cardiologists in Hyderabad.

Frequently Asked Questions

What is an atrial septal defect (ASD)?

An atrial septal defect (ASD) is a congenital heart condition in which there is a hole in the wall (septum) that separates the heart’s two upper chambers, known as the atria. This opening allows oxygen-rich blood from the left atrium to mix with oxygen-poor blood in the right atrium, increasing blood flow to the lungs and placing extra strain on the heart over time.

What are the symptoms of ASD in adults?

Many adults with ASD may have no symptoms for years. When symptoms appear, they can include breathlessness during activity, fatigue, heart palpitations, and recurrent chest infections. Some people experience swelling in the legs or irregular heart rhythms. Symptoms often become more noticeable as the heart and lungs face prolonged increased workload.

How is ASD diagnosed?

ASD is diagnosed through clinical evaluation and imaging tests. A doctor may detect a heart murmur during examination. An echocardiogram is the main diagnostic test, as it uses ultrasound to visualise the heart’s structure and blood flow. Additional tests such as an electrocardiogram (ECG), chest X-ray, or cardiac MRI may provide further detail.

Can ASD lead to heart failure or pulmonary hypertension?

Yes, untreated ASD can increase pressure in the pulmonary arteries due to excess blood flow to the lungs. Over time, this may result in pulmonary hypertension and strain on the right side of the heart. Persistent overload can eventually lead to heart failure or serious rhythm disturbances.

What happens if ASD is left untreated?

If ASD remains untreated, long-term complications may develop. These include arrhythmias, stroke caused by blood clots, pulmonary hypertension, and progressive heart enlargement. Early detection and appropriate management reduce the risk of permanent heart and lung damage and improve long-term outcomes.