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 of‘second heart sound.
- There is tricuspid mid diastolic flow murmur in the
- tricuspid area.
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