A hole in the heart might sound like something from a horror movie, but it’s actually a real medical condition that can affect adults. While most people think of heart defects as something babies are born with, many adults live with undiagnosed holes in their hearts — sometimes for decades. Others develop heart issues later in life that mimic or lead to similar problems.
So, what causes a hole in the heart in adults? Is it always something you’re born with? Can it form later in life? And what should you do if you suspect you might have one?
In this article, we’ll break down everything you need to know about holes in the heart in adults — in simple, easy-to-understand language. We’ll cover the types, causes, symptoms, how doctors diagnose it, treatment options, and what happens if it’s left untreated. Whether you’re asking for yourself, a loved one, or just curious, this guide will give you clear, accurate, and trustworthy answers.
What Is a Hole in the Heart?
Before we dive into causes, let’s understand what a “hole in the heart” really means.
A hole in the heart refers to an abnormal opening between the chambers of the heart. The heart has four chambers: two upper chambers (called atria) and two lower chambers (called ventricles). Normally, these chambers are separated by walls called septa. When there’s a hole, blood can flow where it shouldn’t — mixing oxygen-rich and oxygen-poor blood.
This can make the heart work harder and, over time, damage the heart and lungs.
There are two main types of holes in the heart:
- Atrial Septal Defect (ASD): A hole in the wall between the upper chambers (atria).
- Ventricular Septal Defect (VSD): A hole in the wall between the lower chambers (ventricles).
Most of the time, these defects are present at birth — meaning people are born with them. But they might not be discovered until adulthood.
Can Adults Develop a Hole in the Heart Later in Life?
Yes and no — it depends on what you mean by “develop.”
Most Holes Are Present at Birth
The vast majority of holes in the heart are congenital heart defects, meaning they happen during fetal development, before birth. So technically, adults don’t “develop” these holes later in life — they’ve had them since birth.
But here’s the catch: many people don’t know they have a hole in their heart until they’re adults. Small holes may cause no symptoms and go unnoticed for years. A doctor might only find it during a routine check-up or when investigating another issue.
Rare Cases: Holes That Form After Birth
While extremely rare, there are situations where a hole can form in the heart after birth, even in adulthood. These are usually due to:
- Severe heart attacks that damage heart tissue
- Trauma to the chest (like from an accident)
- Complications from heart surgery
For example, a large heart attack can weaken the heart muscle so much that a tear forms between chambers — this is called a ventricular septal rupture. It’s a medical emergency and very dangerous.
So, while most adult cases are due to undiagnosed childhood defects, in rare cases, holes can truly form later in life because of injury or disease.
What Causes a Congenital Hole in the Heart?
If most holes are present at birth, what causes them to form in the first place?
Scientists and doctors don’t always know the exact cause, but research shows several factors can increase the risk of a baby being born with a hole in the heart.
Genetics and Family History
Some heart defects run in families. If a parent or sibling has a congenital heart defect, the chances are slightly higher that a baby might have one too. Certain genetic conditions — like Down syndrome — are also linked to a higher risk of heart defects, including holes.
Problems During Fetal Development
The heart starts forming early in pregnancy — around 5 to 6 weeks. If something interferes with this process, a hole can form.
For example:
- The septum (the wall between chambers) may not grow fully.
- Tissues may not fuse together properly.
- Blood flow patterns in the developing heart may affect how the walls form.
These issues usually happen by chance, but some factors make them more likely.
Maternal Health and Lifestyle During Pregnancy
A mother’s health during pregnancy plays a big role. Things that can raise the risk include:
- Diabetes (especially if not well-controlled)
- Rubella (German measles) infection during early pregnancy
- Use of certain medications (like some anti-seizure drugs)
- Alcohol or drug use
- Smoking during pregnancy
- Obesity
It’s important to note: having one of these risk factors doesn’t mean a baby will definitely have a heart defect. But they increase the chances.
Doctors recommend that women planning pregnancy get proper prenatal care, take folic acid, avoid harmful substances, and manage chronic conditions like diabetes.
Why Are Some Holes in the Heart Not Found Until Adulthood?
Many adults live with a hole in the heart and don’t even know it. How is that possible?
Small Holes May Cause No Symptoms
Some holes are tiny. They don’t let much blood pass through, so the heart can still work normally. These are often called “silent” defects because they don’t cause noticeable problems.
A small atrial septal defect (ASD), for example, might not affect a person until middle age — or ever.
Symptoms Can Be Mild or Mistaken for Other Issues
When symptoms do appear, they’re often subtle and can be confused with other conditions like asthma, anxiety, or aging.
Common symptoms include:
- Getting tired easily during exercise
- Shortness of breath
- Frequent lung infections
- Heart palpitations (feeling your heart race or flutter)
Because these signs are common and vague, people may not think to see a heart specialist.
Lack of Routine Heart Screening
Unlike blood pressure or cholesterol checks, most adults don’t get routine heart structure tests — like echocardiograms — unless there’s a reason to suspect a problem.
So, unless a doctor hears a heart murmur or orders a scan for another reason, the hole may go undetected.
Improved Detection Over Time
Thanks to better imaging technology (like echocardiograms and MRIs), more adults are now being diagnosed with holes they’ve had since birth. What used to go unnoticed can now be seen clearly on a screen.
What Are the Types of Holes in the Heart in Adults?
Not all holes are the same. The type and location matter a lot when it comes to symptoms and treatment.
Let’s look at the main types:
Atrial Septal Defect (ASD)
An ASD is a hole in the wall between the two upper chambers of the heart (the atria).
There are different kinds of ASDs:
- Secundum ASD: The most common type. It’s in the middle of the atrial wall.
- Primum ASD: Located in the lower part of the atrial wall. Often linked with other heart defects.
- Sinus Venosus ASD: Near the veins that bring blood to the heart. May affect how blood flows.
- Coronary Sinus ASD: A rare type near a vein in the back of the heart.
In adults, secundum ASD is the most likely to go unnoticed for years. Many people with this type live into their 40s, 50s, or beyond before it’s found.
Ventricular Septal Defect (VSD)
A VSD is a hole between the lower chambers (ventricles). This is the most common type of congenital heart defect in babies.
But here’s the good news: many small VSDs close on their own during childhood. Larger ones are usually treated early.
So, if an adult has a VSD, it’s often because:
- It was small and never closed completely
- It was missed in childhood
- It’s part of a more complex heart condition
VSDs in adults are less common than ASDs but can still cause problems if not treated.
Patent Foramen Ovale (PFO)
This isn’t exactly a “hole,” but it acts like one.
Everyone is born with a small flap-like opening between the atria called the foramen ovale. Before birth, it helps blood bypass the lungs. Normally, it closes shortly after birth.
But in about 1 in 4 people, it never fully closes. This is called a patent foramen ovale (PFO).
Most people with a PFO have no symptoms and never know they have it. But in some cases, it can increase the risk of stroke — especially in younger adults with no other risk factors.
PFOs are often found during tests for stroke or migraines.
What Are the Symptoms of a Hole in the Heart in Adults?
Not everyone with a hole in the heart has symptoms. But when they do appear, they often get worse over time.
Common signs include:
Shortness of Breath, Especially During Activity
One of the most common symptoms. You might feel winded walking up stairs, exercising, or doing simple tasks. This happens because the heart isn’t pumping efficiently, and the lungs may get too much blood.
Fatigue and Low Energy
Even with enough sleep, you might feel unusually tired. Your body isn’t getting enough oxygen-rich blood, so you feel drained.
Heart Palpitations
You might feel your heart racing, fluttering, or skipping beats. This can be due to the heart working harder or abnormal heart rhythms (arrhythmias) caused by the extra strain.
Swelling in the Legs, Feet, or Abdomen
This is a sign of right-sided heart failure. When the right side of the heart is overworked (common in ASD), fluid can build up in the legs and belly.
Frequent Lung Infections
Extra blood flow to the lungs can make them more prone to infections like pneumonia or bronchitis.
Stroke (Especially with PFO)
A PFO can allow small blood clots to pass from the right side of the heart to the left — and then travel to the brain, causing a stroke. This is called a paradoxical embolism.
Some people discover they have a PFO only after having a stroke with no clear cause.
How Is a Hole in the Heart Diagnosed in Adults?
If your doctor suspects a hole in your heart, they’ll use several tests to confirm it.
Physical Exam and Heart Murmur
During a check-up, your doctor might hear a heart murmur — an unusual sound caused by blood flowing abnormally through the heart. Not all murmurs mean a hole, but it’s often the first clue.
Echocardiogram (Echo)
This is the main test used to diagnose holes in the heart.
An echocardiogram uses sound waves to create moving pictures of your heart. It shows:
- The size and location of the hole
- How much blood is leaking through
- How well the heart is pumping
There are two types:
- Transthoracic echo (TTE): A wand is moved over your chest.
- Transesophageal echo (TEE): A small tube goes down your throat for a clearer view. Used when the regular echo isn’t clear enough.
Electrocardiogram (EKG or ECG)
This test checks your heart’s electrical activity. It can show signs of strain on the right side of the heart, which is common in ASD.
Chest X-ray
Shows the size and shape of your heart and lungs. A larger-than-normal heart or swollen lung vessels can suggest a hole.
Cardiac MRI or CT Scan
These advanced imaging tests give detailed pictures of the heart. They’re used when echo results aren’t clear or for complex cases.
Bubble Study (Agitated Saline Study)
Often done with an echo. A small amount of agitated saline (salt water with tiny bubbles) is injected into a vein. If there’s a hole, the bubbles will appear on the left side of the heart when they shouldn’t — confirming a shunt.
This test is especially helpful for finding PFOs.
What Happens If a Hole in the Heart Is Left Untreated?
Some small holes may never cause problems. But larger ones can lead to serious complications over time — especially if left untreated.
Pulmonary Hypertension
This is high blood pressure in the lungs. When too much blood flows to the lungs (due to the hole), the lung arteries can become thick and stiff. This forces the right side of the heart to work harder.
If this continues, it can lead to Eisenmenger syndrome — a severe, irreversible condition where the blood flow reverses and oxygen levels drop dangerously low.
Once this happens, surgery is no longer an option.
Heart Failure
The heart may weaken over time from pumping extra blood. Symptoms include fatigue, swelling, and shortness of breath.
Arrhythmias (Irregular Heartbeats)
A stretched or enlarged heart can develop abnormal rhythms like atrial fibrillation or atrial flutter. These increase the risk of stroke and need treatment.
Stroke
As mentioned, a PFO or large ASD can allow clots to bypass the lungs and go straight to the brain.
Reduced Life Expectancy
While many people with small holes live normal lives, untreated larger defects can shorten lifespan. The risk increases with age and the size of the defect.
That’s why early diagnosis and treatment are so important.
How Is a Hole in the Heart Treated in Adults?
Treatment depends on the type, size, location, and symptoms.
Watchful Waiting (No Treatment)
If the hole is small and causes no symptoms, your doctor may recommend monitoring instead of treatment. This includes regular check-ups and echocardiograms to watch for changes.
Many adults with small ASDs or PFOs fall into this category.
Medications
While medicines can’t close the hole, they can help manage symptoms and complications:
- Diuretics to reduce fluid buildup (for swelling)
- Blood thinners (like aspirin or warfarin) to prevent clots, especially with PFO and stroke risk
- Medications for arrhythmias (like beta-blockers)
- Drugs for pulmonary hypertension (if present)
Medications are often used alongside or before procedures.
Catheter-Based Closure (Minimally Invasive)
This is the most common treatment for suitable ASDs and PFOs.
During the procedure:
- A thin tube (catheter) is inserted into a vein in the groin.
- It’s guided to the heart.
- A small device (like a mesh plug or occluder) is placed over the hole to close it.
Benefits:
- No open-heart surgery
- Short hospital stay (usually 1–2 days)
- Faster recovery
Not all holes can be closed this way — it depends on size, shape, and location.
Open-Heart Surgery
For large holes, complex defects, or when catheter closure isn’t possible, surgery may be needed.
During surgery:
- The chest is opened
- The heart is stopped and connected to a heart-lung machine
- The hole is stitched or patched
Recovery takes longer — usually 6–8 weeks — but the success rate is high.
Hybrid Procedures
In rare cases, doctors use a mix of surgery and catheter techniques, especially for hard-to-reach defects.
Can a Hole in the Heart Close on Its Own in Adults?
In babies, small VSDs often close on their own as the heart grows.
But in adults? No. Once you’re an adult, the heart doesn’t grow or change enough for a hole to close naturally.
If a small hole was thought to have “closed,” it was likely never there — or it was so tiny it didn’t matter.
Any hole that remains in adulthood will not go away without treatment.
Can You Live a Normal Life With a Hole in the Heart?
Yes — many adults do.
If the hole is small or has been successfully closed, most people can:
- Exercise normally
- Have children
- Live a full, active life
Even after treatment, regular follow-ups with a cardiologist are important to make sure the heart stays healthy.
People with repaired defects are often advised to:
- Maintain a heart-healthy lifestyle (good diet, exercise, no smoking)
- Take antibiotics before dental work (in some cases, to prevent infection)
- Monitor for new symptoms
With proper care, the outlook is excellent.
Can a Hole in the Heart Cause a Stroke?
Yes — especially in cases of PFO.
Here’s how:
- A small blood clot forms in a vein (like in the leg — deep vein thrombosis).
- Instead of being filtered by the lungs, the clot passes through the PFO from the right to the left side of the heart.
- It then goes to the brain and causes a stroke.
This is called a paradoxical embolism.
Studies show that closing a PFO can reduce the risk of future strokes in certain patients — especially younger adults with no other stroke causes.
Not everyone with a PFO needs closure — only those who’ve had a stroke and meet specific criteria.
Can Stress or Lifestyle Cause a Hole in the Heart?
No. Stress, poor diet, lack of exercise, or smoking do not cause a congenital hole in the heart.
However, these factors can:
- Worsen symptoms
- Increase the risk of complications (like high blood pressure or heart disease)
- Make the heart work harder
So while they don’t create the hole, they can make living with it more dangerous.
That’s why heart-healthy habits are so important — even if you were born with a defect.
Can You Exercise With a Hole in the Heart?
Most people can — but it depends.
If the hole is small and you have no symptoms, you can usually exercise safely.
If the hole is large or you have complications (like pulmonary hypertension), your doctor may limit intense physical activity.
Always talk to your cardiologist before starting a new exercise routine.
Many people go on to run marathons, swim, or play sports after treatment.
Can Women With a Hole in the Heart Have a Safe Pregnancy?
Yes — but it depends on the size of the hole and heart function.
Pregnancy puts extra stress on the heart. Blood volume increases by up to 50%, which can be risky if the heart is already strained.
Women with:
- Small, closed, or treated defects usually have safe pregnancies.
- Large untreated holes or pulmonary hypertension face higher risks, including heart failure or stroke.
It’s crucial to consult a high-risk obstetrician and cardiologist before getting pregnant. They can assess your heart and plan a safe pregnancy journey.
Is a Hole in the Heart Hereditary?
It can be — but not always.
Most cases happen by chance. However, your risk is slightly higher if:
- A parent or sibling has a congenital heart defect
- You have a genetic syndrome linked to heart defects (like Down, Marfan, or Turner syndrome)
Genetic counseling can help families understand risks for future children.
Can a Hole in the Heart Be Prevented?
You can’t prevent congenital heart defects entirely — but you can reduce the risk.
For women who are pregnant or planning pregnancy:
- Get early and regular prenatal care
- Take folic acid supplements
- Manage chronic conditions (diabetes, high blood pressure)
- Avoid alcohol, smoking, and recreational drugs
- Stay up to date on vaccines (especially rubella)
- Talk to your doctor about medications
These steps won’t guarantee a perfect heart, but they improve the odds.
When Should You See a Doctor?
See a cardiologist if you have:
- Unexplained shortness of breath
- Constant fatigue
- Heart palpitations
- Swelling in legs or abdomen
- A history of stroke (especially under age 60)
- A known heart murmur
Even if symptoms are mild, it’s worth getting checked. Early detection can prevent serious problems later.
Summary: What Causes a Hole in the Heart in Adults?
To sum it all up:
- Most holes in the heart in adults are congenital — meaning they were present at birth but not diagnosed until later.
- Common types include ASD, VSD, and PFO.
- Causes include genetics, maternal health during pregnancy, and random developmental issues.
- Adults don’t usually “develop” holes later — but rare cases can occur due to heart attacks or trauma.
- Symptoms may include fatigue, shortness of breath, palpitations, and swelling.
- Diagnosis involves echocardiograms, EKGs, and imaging tests.
- Treatment ranges from monitoring to catheter closure or surgery.
- Untreated holes can lead to pulmonary hypertension, heart failure, or stroke.
- Most people can live normal lives with proper care.
The key takeaway? A hole in the heart isn’t always dangerous — but it shouldn’t be ignored. With modern medicine, most cases can be managed or fixed.
If you suspect you might have one, talk to your doctor. A simple test could change your life.
Real-Life Scenario
Consider a 40-year-old adult who often feels tired, short of breath, and experiences heart palpitations. After medical tests, the doctor discovers an atrial septal defect (ASD) that went unnoticed since childhood. Such cases are not rare—many people live for years without symptoms, only discovering the hole later in life during routine checkups or after developing heart-related issues.
Expert Contribution
Cardiologists explain that not all holes in the heart cause immediate problems. Small defects may go unnoticed, but larger ones can lead to high blood pressure in the lungs (pulmonary hypertension), stroke, or heart failure if untreated.
Experts recommend echocardiography (heart ultrasound) as the best diagnostic tool to detect holes in the heart. In many cases, minimally invasive procedures or surgery can close the defect successfully.
Recommendations Grounded in Proven Research and Facts
- Get regular checkups: Adults with unexplained fatigue or breathing issues should consider a heart evaluation.
- Monitor symptoms: Shortness of breath, swelling in legs, frequent fatigue, or irregular heartbeat may point to a heart defect.
- Seek early treatment: According to the American Heart Association, timely closure of large defects reduces the risk of heart failure and stroke.
- Adopt a heart-healthy lifestyle: Balanced diet, exercise, and avoiding smoking help lower the risks of complications.
- Follow doctor’s advice: Medication, surgery, or catheter-based closure may be recommended based on defect size and symptoms.
Frequently Asked Questions (FAQ) on What Causes a Hole in the Heart in Adults?
Can a hole in the heart cause death?
Yes, if left untreated and severe. Large holes can lead to heart failure, pulmonary hypertension, or stroke — all of which can be life-threatening. But with proper treatment, most people live long, healthy lives.
Can stress cause a hole in the heart?
No. Stress does not cause congenital heart defects. However, chronic stress can worsen heart health and increase blood pressure, making existing heart problems worse.
Do holes in the heart get bigger over time?
No, the hole itself doesn’t grow. But the effects — like heart enlargement or lung damage — can get worse if untreated.
Can a hole in the heart be seen on an X-ray?
Sometimes. A chest X-ray may show an enlarged heart or swollen lung arteries, which can suggest a hole. But it can’t confirm it — an echocardiogram is needed for diagnosis.
Is a hole in the heart considered a disability?
Not usually. Most people with small or treated holes can live normally. But if the defect causes severe limitations, it may qualify for disability benefits — evaluated case by case.
Can you drink alcohol with a hole in the heart?
In moderation, yes — if your heart is stable. But alcohol can raise blood pressure and trigger arrhythmias, so it’s best to limit intake and consult your doctor.
Can a hole in the heart cause anxiety?
Not directly. But symptoms like palpitations and shortness of breath can feel like anxiety. Some people mistake heart symptoms for panic attacks — so proper diagnosis is key.
How common is a hole in the heart in adults?
Very common — especially PFO. About 1 in 4 adults has a PFO. ASD occurs in about 1 in 1,500 adults. Many go undiagnosed.
Can a hole in the heart be fixed without surgery?
Yes. Many ASDs and PFOs can be closed using a catheter procedure — no open surgery needed.
Does a hole in the heart make you tired?
Yes. Because the heart has to work harder and oxygen delivery is less efficient, fatigue is a common symptom.
Can a hole in the heart cause high blood pressure?
Not directly. But it can cause pulmonary hypertension (high blood pressure in the lungs), which is different from regular high blood pressure.
Can you fly with a hole in the heart?
Yes, most people can. Commercial flights are generally safe. But if you have severe heart or lung complications, check with your doctor first.
Can a hole in the heart cause migraines?
Some studies suggest a link between PFO and migraines with aura. Closing the PFO may help reduce migraines in some people — but results vary.
Is a hole in the heart rare?
No. Congenital heart defects are the most common type of birth defect. Holes like ASD and PFO are actually quite common — especially when undiagnosed.
Can a baby be born with a hole in the heart and be normal?
Yes. Many babies are born with small holes that close on their own or cause no issues. With treatment, most children with heart defects grow up healthy.
