Patients with an atrial septal defect typically demonstrate a widely split and fixed second heart sound, that is, there is no perceptible variation in the splitting interval with respiration. A universal finding is the systolic murmur similar to that heard in our patient. The murmur reflects turbulence in the pulmonic trunk secondary to increased flow. In addition, patients with an atrial septal defect may manifest a palpable right ventricular impulse and a pulmonary artery impulse. A mid diastolic right ventricular filling murmur at the lower left sternal edge confirms the diagnosis.