Patients may not become symptomatic until adult
life. Symptoms include dyspnea, orthopnea, paroxysmal nocturnal dyspnea,
decreased exercise tolerance, and palpitations. There may be signs of right
ventricular failure. A loud S1 (mitral stenosis) with fixed splitting
of S2 (atrial septal defect) is usually heard. A diastolic parasternal
murmur may be heard and represents increased flow across the tricuspid
valve. Electrocardiographic findings include atrial flutter, atrial fibrillation, incomplete
or complete right bundle branch block, right ventricular hypertrophy, and
right-axis deviation. The chest radiograph demonstrates right atrial
enlargement and prominent pulmonary vasculature and may show signs of
pulmonary venous congestion.