A young guy came in as a walk-in with some mild shortness of breath on exertion and associated chest pain. He was the last patient that I saw during a long, busy day and his symptoms were very mild. I was thinking that maybe he had mild asthma or a respiratory infection, but he didn’t look sick at all. Then I listened to his heart. A loud holosystolic murmur throughout with a fixed split S2. Wait, wait. I know this one…. (sounds of my mind clunking along) ASD - Atrial Septal Defect (Patient Information).

He had his echocardiogram today which confirmed that he had a large ASD (We don’t need no stinking echo!). He’ll be going to Bellevue for repair and most likely will do very well. I explained everything to him (in Spanish “un agujero in su corazón”). It’s times like these that make me glad that I get to do what I do.