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 arrhythmias – atrial 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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