Atrial septal defect: Difference between revisions
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**Large notches signify a larger shunt | **Large notches signify a larger shunt | ||
*Incomplete [[right bundle branch block]], very sensitive | *Incomplete [[right bundle branch block]], very sensitive | ||
*[[1st degree | *[[1st degree AV block]] | ||
*Atrial dysrhythmias | *Atrial dysrhythmias | ||
*[[Right axis deviation]] ([[pulmonary hypertension]]) | *[[Right axis deviation]] ([[pulmonary hypertension]]) | ||
Revision as of 05:17, 6 August 2016
Background
- Many ASDs go undiagnosed in childhood
- By 40s, patients may develop symptoms
Clinical Features
A patient may be asymptomatic or have any of the following features:
- Dyspnea on Exertion
- CHF
- Palpitations
- Syncope
- Pulmonary hypertension
- Right heart failure
- A. fib
- Stroke (via an embolism)
Differential Diagnosis
Congenital Heart Disease Types
- Cyanotic
- Acyanotic
- AV canal defect
- Atrial septal defect (ASD)
- Ventricular septal defect (VSD)
- Cor triatriatum
- Patent ductus arteriosus (PDA)
- Pulmonary/aortic stenosis
- Coarctation of the aorta
- Differentiation by pulmonary vascularity on CXR[1]
- Increased pulmonary vascularity
- Decreased pulmonary vascularity
- Tetralogy of fallot
- Rare heart diseases with pulmonic stenosis
Evaluation
- An ECG may show the “crochetage” pattern (92% specific)—a notch near the apex of the R wave in inferior limb leads[2]
- Large notches signify a larger shunt
- Incomplete right bundle branch block, very sensitive
- 1st degree AV block
- Atrial dysrhythmias
- Right axis deviation (pulmonary hypertension)
Management
Disposition
- Generally unless there is a complication, the septal defect if found incidentally can be evaluated as an outpatient with elective repair
See Also
External Links
References
- ↑ Knipe K et al. Cyanotic congenital heart diseases. Radiopaedia. http://radiopaedia.org/articles/cyanotic-congenital-heart-disease
- ↑ Heller, J et al. “Crochetage” (Notch) on R wave in inferior limb leads: A new independent electrocardiographic sign of atrial septal defect. J Am Coll Cardiol. 1996;27(4):877-882 full text]