Possible ASD excluded by echo or not

Hi All,

I am 37 years old male with no major illness history before I started having issues for about 4 years ago. I have no ASD diagnosis, but one pulmonary specialist said it could explain my symptoms very well. I did propose this idea to my GP but he said that because I have transthoracic echo done 3 years ago (normal 2D echo, no bubbles), it is not a possibility.

Has anyone of you guys had ASD and it not showing / not noticed in normal transthoracic echo?

I have been constantly fatigued and lightheaded almost 4 years now without proper diagnosis. It is not just being tired.. it's debilitating.I also have arrhythmias - ectopic beats and irregular rhythm (sometimes bradycardia).

The reason why this pulmonary specialist wondered about ASD is that I had arterial blood gases analyzed during sleep study and it appears that the partial pressure of oxygen is low 67 mmHg and my lungs test out just fine. My oxygen saturation is a bit on the low side as well - typically 95 or 96%. I have understood that ASD could cause this because the non-oxygenated blood can mix with oxygenated blood in the heart.

Any insight would be highly appreciated!

I don’t have answers for you, dan, but I hope you get a proper diagnosis soon. I have shared your discussion with our members, and I hope some of them can advise you.

Hello Dan
i would recommend another echo. I had two detailed transthoracic echos done at very good centres which did not show an ASD (even though they were looking for now), but did show mild mitral incompetence. I then went to the specialist congenital heart centre (i'm in London, UK) and had another echo which showed an ASD, My case was complicated as i had had an ASD closed by open heart surgery as a teenager in the 1970s, and this was 30 years later in my late 40s. Seems the closure had come undone a bit.
Even in the best hands echo investigations are tricky. I trans-oesophageal one would be better.
I have since had two small ASDs closed with Amplatzer devices and my light-headedness and fatigue have gone - in fact i am fitter than i have been for decades.
good luck

I had one TEE show significant shunting and a second one show none. I would recommend you get another, perhaps Transcranial?

Would insist on another echo, preferably a TEE?

I felt like I was going to die. Could not walk to my car, had to sit all the time, no energy, taking a shower was too much for me and still is at times. Finally, I checked myself into the ER. Because I was having chest pains they kept me until the next day to do more testing. I was in the middle of the echo and I don't think the tech was seeing anything until I said "You wouldn't see a hole would you, my mother had one!" Then, she started looking harder. The cardiologist told me they found it by "accident". Then, they followed up by going down my throat Transthoracic echo to take a look and followed up with ASD closure. I felt great for a while but then started having symptoms again. A year and a half later they did a double heart cath and I have afib and diastolic dysfunction with left ventricle stiffening. I knew that I was not "right" and kept pushing the doctors. Even an hour before the heart cath the doctor told me I didn't need to drive an hour to see him. You should have seen his face when he asked for four different cardiologists during my heart cath. The reason I am telling you this is that you should listen to your body and be your own advocate. Doctors are busy and somtimes they can't see the forest for the trees! Now, I have been sent to a gasteroenterologist to see if Esophogeal issues are involved also. They are proceding with an upper gi test. You don't have heartburn, acid indegestion or anything with your symptoms do you? Take care and I hope you find answers soon. I know how frustrating and expensive it all can be! Best to you!

By the way I test out fine with stress tests, oxygen, and everything too. Had every blood test possible.

I would go to a cardiologist explain symptoms and see if he feels a bubble echo would be smart. It’s always better to be safe than sorry. That way you will get peace of mind and know to look in other directions if it comes back negative. Good luck, I know the fatigue is both physically and mentally hard. Focus on the beautiful things in life to get your days and life will be happier.