▁accident ▁( stroke ). ▁ ▁They ▁may ▁be ▁noted ▁on ▁routine ▁testing ▁to ▁have ▁an ▁ab normal ▁ch est ▁X - ray ▁or ▁an ▁ab normal ▁E CG ▁and ▁may ▁have ▁at rial ▁f ibr ill ation . ▁ ▁If ▁the ▁AS D ▁causes ▁a ▁left - to - right ▁sh unt , ▁the ▁pul mon ary ▁vas cul ature ▁in ▁both ▁l ungs ▁may ▁appear ▁dil ated ▁on ▁ch est ▁X - ray , ▁due ▁to ▁the ▁increase ▁in ▁pul mon ary ▁blood ▁flow . ▁ ▁Phys ical ▁exam ination ▁ ▁The ▁physical ▁find ings ▁in ▁an ▁adult ▁with ▁an ▁AS D ▁include ▁those ▁related ▁directly ▁to ▁the ▁int rac ard iac ▁sh unt ▁and ▁those ▁that ▁are ▁secondary ▁to ▁the ▁right ▁heart ▁failure ▁that ▁may ▁be ▁present ▁in ▁these ▁individuals . ▁ ▁Upon ▁aus c ult ation ▁of ▁the ▁heart ▁sounds , ▁ ▁a ▁syst ol ic ▁e jection ▁murm ur ▁may ▁be ▁heard ▁that ▁is ▁attributed ▁to ▁the ▁pul mon ic ▁val ve , ▁due ▁to ▁the ▁increased ▁flow ▁of ▁blood ▁through ▁the ▁pul mon ic ▁val ve ▁rather ▁than ▁any ▁struct ural ▁ab normal ity ▁of ▁the ▁val ve ▁leaf lets . ▁ ▁In ▁una ffect ed ▁individuals , ▁resp ir atory ▁variations ▁occur ▁in ▁the ▁splitting ▁of ▁the ▁second ▁heart ▁sound ▁( S 2 ). ▁ ▁During ▁resp ir atory ▁insp iration , ▁the ▁negative ▁intr ath or ac ic ▁pressure ▁causes ▁increased ▁blood ▁return ▁into ▁the ▁right ▁side ▁of ▁the ▁heart . ▁ ▁The ▁increased ▁blood ▁volume