A “hole in the heart” typically refers to a septal defect, an abnormal opening in the wall separating the heart’s chambers. Common types include a Patent Foramen Ovale (PFO) or an Atrial Septal Defect (ASD) between the upper chambers, or a Ventricular Septal Defect (VSD) between the lower chambers. While small defects may cause no issues, larger or symptomatic defects can lead to volume overload, irregular heart rhythms, or a paradoxical embolism, where a blood clot bypasses the lungs and travels to the brain. Managing life with a septal defect requires avoiding specific activities and behaviors that increase strain on the heart or raise the risk of these serious complications, depending on the defect’s size and location.
Physical Activities and Environmental Restrictions
Individuals with a septal defect should moderate physical activities that dramatically increase intrathoracic pressure or cause severe breathlessness. High-intensity resistance training, particularly heavy weightlifting, should be avoided because it often involves the Valsalva maneuver, a technique of forced exhalation against a closed airway. This maneuver significantly increases chest pressure, which can temporarily reverse blood flow through the defect (right-to-left shunting), increasing the risk of a paradoxical embolism if a blood clot is present in the venous system.
Competitive sports and activities that lead to extreme exertion may also need restriction, especially if the defect is large or associated with pulmonary hypertension. However, most patients with simple or successfully repaired defects can safely engage in moderate-intensity aerobic exercise, which is beneficial for overall cardiovascular health. The general recommendation is to avoid activities that cause maximum exertion and to discuss an individualized exercise plan with a healthcare provider.
Environmental exposure to significant pressure changes must be avoided, especially deep-sea scuba diving. During deep dives, nitrogen gas dissolves into the body’s tissues and forms bubbles in the veins upon ascent. In a person with a PFO or ASD, these venous bubbles can cross the defect into the arterial circulation, potentially causing an arterial gas embolism (a form of decompression illness) that affects the brain or other organs. While the absolute risk of decompression illness is low, divers with a known PFO are advised to avoid deep dives, limit depth to less than 15 meters, or consider using enriched air nitrox to minimize nitrogen load.
Lifestyle Choices and Substance Use
Abstaining from all forms of tobacco is necessary for anyone with a heart defect, as smoking causes widespread damage to blood vessels and increases the risk of blood clots. Nicotine exposure, whether active or passive, promotes inflammation and hypercoagulability, significantly raising the risk for stroke, which is amplified by the potential for paradoxical embolism in PFO and ASD. Smoking cessation reduces overall cardiovascular risk in this patient population.
Excessive consumption of alcohol and caffeine should be moderated, as both substances can strain the heart and potentially trigger irregular heart rhythms. Limiting intake to one drink per day for women and two for men is generally advised, as heavy alcohol use is linked to an increased stroke risk. Furthermore, any use of illegal intravenous drugs must be strictly avoided due to the immediate risk of introducing bacteria into the bloodstream, which can cause infective endocarditis.
Dietary choices require modification if the defect contributes to heart failure symptoms, such as shortness of breath or ankle swelling. Avoiding high-sodium foods is helpful because excessive salt intake can lead to fluid retention, increasing the volume load on the heart. Adopting a heart-healthy diet rich in fiber, whole grains, and fresh produce supports blood pressure and cholesterol control.
Medical Procedures and Infection Prevention
A primary concern for individuals with septal defects, especially those with unrepaired defects or prosthetic repair material, is avoiding infections that can lead to infective endocarditis. Infective endocarditis is a serious infection of the heart’s inner lining or valves, which places severe stress on the heart structure. This infection typically occurs when bacteria from another site, such as the mouth, enter the bloodstream.
Patients in the highest risk categories must not skip prophylactic antibiotics before certain invasive procedures, especially dental work that involves manipulating the gums or tooth roots. Guidelines recommend antibiotics for those with unrepaired cyanotic defects or for six months following the placement of a prosthetic device for defect closure. A consultation with a cardiologist is necessary to confirm the need for this antibiotic regimen before any procedure that may cause bacteremia.
Ignoring or delaying medical attention for new or worsening symptoms is a serious avoidance. Symptoms such as unexplained persistent fever, sudden shortness of breath, chest pain, or signs of a stroke (like sudden weakness or difficulty speaking) demand immediate professional evaluation. Delaying care allows life-threatening complications, such as endocarditis or stroke from embolism, to progress unchecked.
Stopping prescribed medications without explicit medical guidance is also critical, particularly if the patient is taking antiplatelet agents or anticoagulants. These medications are often prescribed to manage the risk of blood clot formation associated with the heart defect or its repair. Non-adherence is a major factor in poor outcomes and increased risk of hospitalization. Finally, neglecting routine preventative care, such as annual influenza and pneumonia vaccinations, should be avoided, as any systemic infection can place undue stress on the heart.