Atrial Septal Defect ASD Clinical features Physical Exam with Treatment

Atrial Septal Defect Clinical features Physical Exam with Treatment

                   Ostium secundum atrial septal defect

Most common is ostium secundumASD, located at mid interatrial septum. It is a simple and common type of ASD with shunt from LA to RA. Usually asymptomatic and acyanotic in children and young adults.

Atrial Septal Defect Clinical features

  • More common in females Presents usually in fourth decade.
  • May present in infants, with features of left-to-right shunt i.e. dyspnoea, fatigue, recurrent lower respira­tory tract infections.
  • Adults have left ventricular failure
  • Atrial arrhythmiasatrial fibrillation is common JVP is normal or raised.
  • There is hyperdynamic right ventricular impulse. Di­rated pulmonary artery may give rise to systolic old J­sation over the left second intercostal space.
  • There is a split first heart sound with loud Tl.
  • Talere is grade 2 or 3 pulmonary ejection systolic murmur.
  • There is wide fixed splitting ofsecond heart sound.
  • There is tricuspid mid diastolic flow murmur in the
  • tricuspid area.


Atrial Septal Defect Clinical features


Atrial Septal Defect Clinical features Physical Exam with Treatment

Atrial Septal Defect Physical Exam

  • Infants and children with ASDs tend to be small for their age, even in the absence of complicating factors such as heart failure or other cardiac malformations
  • Signs vary according to extent of shunting:
  • Prominent precordial bulge
  • large left-to-right shunt may result in a precordial bulge due to atrial enlargement
  • Palpable pulmonary artery pulse
  • An enlarged and pulsatile pulmonary artery may be palpated at the second left intercostal space.
  • Pulmonic flow murmur: Systolic ejection murmur
  • Low-pitched diastolic murmur at left lower sternal border
  • Right ventricular lift
  • Fixed, widely split S2
  • characteristic finding in ASDs with large left-to-right shunts and normal pulmonary artery pressure is wide, fixed splitting of the second sound (S2)
  • Cyanosis and clubbing (with severe pulmonary hypertension: Eisenmenger syndrome)

Atrial Septal Defect ECG

  • Ostium secundum: Rightward axis, right ventricular hypertrophy, rSR’ pattern in V1
  • Shows peaked P waves, rSR or Rs pattern in lead Vl ue to left atrial enlargement and right ventricular ypertrophy.
  • Sinus venosus: Leftward axis, inverted P wave in lead III
  • Note: All may be associated with PR prolongation.

Atrial Septal Defect X-ray

  • Chest x-ray: Varying degrees of cardiac enlargement, increased pulmonary vascular workings, right ventricle and pulmonary artery enlargement
  • Shows increased pulmonary arterial vascularity, small ascending aorta, large dilated pulmonary trunk and its branches, dilated right atrium and right ventricle.
  • Echocardiography: Pulmonary arterial and right ventricular dilatation and anterior systolic (paradoxical) septal motion

Atrial Septal Defect Treatment

  • Appropriate health care: Referral to a cardiologist for evaluation
  • Majority of small ASDs will close spontaneously; however, close follow-up is warranted
  • Closure is usually delayed until preschool age (2–4 years), except for large defects to be repaired earlier.
  • Closure via percutaneous transcatheter device or surgery
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