# A Case of Secondary Pulmonary Hypertension in a Patient With Atrial Septal Defect and Fetal Alcohol Syndrome

## TL;DR

A man with fetal alcohol syndrome and a large heart defect developed severe lung high blood pressure, highlighting diagnostic and treatment challenges in adults with cognitive impairments.

## Contribution

Highlights the delayed diagnosis of ASD in adults with FAS and the complexities of managing secondary pulmonary hypertension.

## Key findings

- A 34-year-old man with fetal alcohol syndrome was diagnosed with severe pulmonary hypertension due to a large atrial septal defect.
- The case illustrates diagnostic delays in patients with cognitive impairments.
- Treating pulmonary hypertension in such cases poses a therapeutic dilemma due to risks of shunt closure.

## Abstract

We report a case of a 34-year-old man with fetal alcohol syndrome (FAS) presenting with dyspnea, cough, and hoarse voice. The patient was found to have severe pulmonary hypertension secondary to a large atrial septal defect (ASD). In this article, we discuss the challenges patients with FAS and other patients with cognitive impairments face that could explain the first diagnosis of such a large cardiac birth defect being made in the patient’s adulthood. Moreover, severe pulmonary hypertension due to ASD also presents a therapeutic dilemma, as shunt closure can lead to a worsening of the condition.