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Atrial septal defects (ASDs) (Complications (Eisenmenger's syndrome,…
Atrial septal
defects (ASDs)
Definition
Congenital structural heart defect
with communicating R and L atria
Epidemiology
7% of congenital heart disease
80% are secundum type
Pathophysiology
Primum/partial ASD or AVSD
Defect of AVSD, with intra-atrial communication between the end of atrial septum and AV valves (primum)
Abnormal AV valves, left mitral often has 3 leaflets and leaky/regurgitation (pansystolic murmur as a result)
Secundum ASD
Commonest type
Defect in centre of atrial septum (patent foramen ovale)
Mechanism
Higher pressure in LA causes L-R shunt, with mixing of deox blood with ox blood and increased flow to lungs
Increased flow via pulmonary artery causes pulmonary valve murmur
Over time there is pressure on the lungs, causing arterial constriction and pulmonary HTN
RA pressure may increase>LA, reversing the shunt (Eisenmenger's syndrome)
Clinical
presentation
Children
Asymptomatic
Recurrent chest infections
Adults
SOB
Arrhythmias
Cyanosis
Diagnosis
Examination
Cardio
Irregular pulse (AF in adults); inc JVP
Murmur: ejection systolic on ULSE (ASD); pansystolic (AVSD)
Fixed split S2 (RV stroke vol on inspiration=expiration)
Investigations
Bedside
Obs (sats, RR, HR, BP, temp)
ECG (partial RBBB, RAD; may show arrhythmia in adults)
Imaging
CXR (cardiomegaly, pulmonary vascular markings,
enlarged pulmonary arteries)
ECHO with Doppler (define the ASD defect)
Bloods
Cap blood gas (children), ABG (adults)
FBC, U+E, LFTs
History
FH
Cardiac disorders
DH
Current meds, allergies
PMH
Development and milestones
Vaccinations
Known medical conditions
POH
Antenatal: infections, scans, growth, complications
Perinatal: gestation, delivery, weight, complications
Postnatal: complications
PC/HPC
Chest infections, SOB, palpitations, cyanosis
SH
Living arrangements, nursery/school,
occupation
Management
Surgical
Cardiac catheterisation
Indication: secundum ASDs asap in children; symptomatic adults
MOA: insertion of occlusion devlce
Surgical correction
Indication: AVSD asap in children
MOA: surgical correction via central sternotomy
Conservative
Information, advice, support
Referral to cardio/paeds as needed
Lifestyle (smoking, alcohol, exercise, weight loss)
Vaccinations (influenza)
Complications
Eisenmenger's syndrome
Heart failure
Pulmonary HTN
Paradoxical emboli
DVT causing stroke; RARE
Prognosis
Early surgery (3-5y) can prevent
RHF and arrhythmias in later life
Screening
Antenatal screening programme
Foetal anomaly scan
Newborn examination
Heart sounds