Palpitations may reflect cardiac arrhythmias, which almost always are supraventricular in origin. This occurrence is rare in childhood. Hemoptysis is a rare symptom reflecting either chest infection or the development of pulmonary vascular disease. Chest pain may be evidence of right heart ischemia but does not occur in childhood. More commonly, chest pain may be a manifestation of recurrent bronchitis.
Peripheral edema can occur in adults with cardiac failure.
If only a single vein is anomalous, the physical exam may be entirely normal. With a larger volume of abnormal veins findings on physical exam become similar to those of an uncomplicated atrial septal defect. Impulse in the second left intercostal space reflects pulmonary artery dilation. A soft systolic ejection murmur is heard over the pulmonary area, reflecting turbulence in the pulmonary trunk due to increased right ventricular ejection volume. The second heart sound is widely split at all times but may have normal respiratory variation.