Atrial Septal Aneurysm

Overview

An atrial septal aneurysm is a weak, bulging spot in the wall that divides the two upper chambers of the heart. The upper chambers are called the atria. The wall between them is called the atrial septum. Aneurysm means a bulging or ballooning area. This bulge can flap or move with each heartbeat, but it is not a heart attack or a cancer.

No, it is uncommon. Studies estimate that around 1 in 100 people have an atrial septal aneurysm, and most do not know about it.

An atrial septal aneurysm can be present from birth. It may be noticed at any age, sometimes in a baby during a heart scan, but more often in adults when an echocardiogram is done for a different reason.

Symptoms

Common symptoms

• No symptoms at all
• Occasional palpitations, meaning your heart feels like it pounds, flutters, or skips a beat
• Mild shortness of breath, especially when active
• A feeling of being more aware of your heartbeat

Symptoms in children

• Most children have no symptoms.
• If the bulge is large, a baby may feed slowly, tire during feeds, or breathe faster than usual.
• A child may have trouble gaining weight.

Symptoms in older adults

• Palpitations or an irregular heartbeat
• Shortness of breath with activity
• Unusual fatigue
• A history of a transient ischemic attack, sometimes called a mini-stroke, or a stroke with no obvious cause

Causes

Main causes

• The exact cause is not fully understood.
• It is thought to happen because the heart wall does not form quite as usual before birth.
• The tissue in part of the atrial septum is thinner or more flexible than normal, so it bows out with each heartbeat.
• It is not caused by stress, diet, or anything you did during pregnancy.

Risk factors

• Having a family history of congenital heart disease, meaning heart problems present from birth
• Being born with other heart differences, such as a small opening between the upper chambers called a patent foramen ovale
• Having certain genetic conditions that affect connective tissue, which is the body's supporting framework

When to see a doctor

See a doctor urgently if:

• If you have symptoms of a stroke, such as sudden weakness on one side, trouble speaking, or a sudden severe headache, call your local emergency number right away.
• If you faint, have new chest pain, or feel your heart racing with dizziness, seek urgent medical care the same day.

Book a routine appointment if:

• If you have been told you have an atrial septal aneurysm and have questions about your risk
• If you have mild palpitations, shortness of breath, or unusual tiredness and have never had your heart checked
• If you have a family history of congenital heart disease or unexplained stroke and want a check-up

Diagnosis

An atrial septal aneurysm is usually found when a heart ultrasound, called an echocardiogram, is done for another reason, such as a heart murmur, palpitations, or after a stroke.

Tests that may be done

• Transthoracic echocardiogram, which is an ultrasound through the chest wall
• Transesophageal echocardiogram, where a small probe is passed into the food pipe to get a closer view of the heart
• A bubble study, where tiny bubbles are given through a vein to see if blood passes between the upper chambers
• An electrocardiogram, called an ECG, to check the heart rhythm
• Sometimes a cardiac MRI or CT scan for a more detailed picture

What to expect at your appointment

For a standard heart ultrasound, you lie down while a technician moves a small wand over your chest. It is painless and usually takes 30 to 60 minutes. If you need the transesophageal version, you will be given medicine to make you sleepy, and your throat may feel sore afterward.

Treatment

Treatment depends on your age, symptoms, whether there is also a hole between the chambers, and your risk of blood clots. Many people do not need any treatment at all beyond regular check-ups.

Self-care at home

• Keep your follow-up appointments so your heart can be monitored over time.
• Know the warning signs of stroke and act quickly if they happen.
• Keep blood pressure, cholesterol, and blood sugar in a healthy range if you have those conditions.
• Tell your doctor about any new palpitations, breathlessness, or fainting.

Medical treatments

If your doctor thinks you have a higher risk of stroke, they may suggest taking a daily blood-thinning medicine to help prevent clots. These medicines are sometimes called anticoagulants or antiplatelet medicines. The exact medicine and dose must be chosen by your specialist after discussing your bleeding risk, kidney function, and other health factors.

When is surgery considered?

Surgery is not needed for most people. A procedure to close the bulging area may be considered if there is a large hole in the wall, if you have had a stroke that seems to be linked to the aneurysm, or if you keep having blood clots despite taking blood thinners. This is often done with a thin tube called a catheter, inserted through a vein in the groin, and sometimes with open-heart surgery.

Living with this condition

For most people, an atrial septal aneurysm does not change everyday life. You may not need any treatment, just regular check-ups to make sure nothing changes.

Lifestyle tips

• Stay physically active in a way that feels comfortable; ask your doctor if there are any activities you should avoid.
• Do not smoke, and limit alcohol.
• Manage stress with relaxation, hobbies, and enough sleep.
• Keep up with routine health checks for blood pressure, cholesterol, and blood sugar.

Diet and exercise

A heart-healthy diet includes plenty of vegetables, fruit, whole grains, lean protein, and healthy fats. Most adults should aim for around 150 minutes of moderate activity each week, such as brisk walking, unless your doctor advises otherwise. If you feel breathless, dizzy, or faint while exercising, stop and tell your doctor.

Mental health and emotional wellbeing

Learning you have a heart condition, even one that may be harmless, can feel worrying. It is normal to have questions and some anxiety. Talk to your doctor, and if worry is affecting your daily life, ask about counselling or local talking-therapy services.

Prevention

No, an atrial septal aneurysm cannot be prevented because it forms before birth. However, you can lower your risk of complications by looking after your heart health and following your doctor's advice about any prescribed medicines.

Vaccines

It is a good idea to stay up to date on recommended vaccines, including flu and COVID-19, because infections can put extra strain on the heart.

Screening programmes

There is no routine screening for the general public. If you have a family history of congenital heart disease, tell your doctor. They may decide to examine you or arrange a heart ultrasound.

Complications

If left untreated

• A blood clot may form on the bulging tissue and travel to the brain, causing a stroke or a mini-stroke.
• If the aneurysm is also linked to a hole between the upper chambers, extra blood flow can strain the right side of the heart over time.
• Some people with this condition develop atrial fibrillation, an irregular heart rhythm, which can increase stroke risk.

Long-term outlook

The outlook is generally excellent. Many people with an atrial septal aneurysm live a normal, full life and never know they have it. When treatment is needed, options are safe and successful at preventing complications. Your healthcare team will help you decide what is right for you.

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