Atrial Septal Defect (ASD) скачать в хорошем качестве

Atrial Septal Defect (ASD)

Children with small-to-moderate size atrial septal defects are usually asymptomatic. Even moderate-to-large size defects may not present overtly until adulthood. Rarely, very large defects may result in symptoms early in life related to pulmonary edema and high-output cardiac failure. If a lesion with a significant degree of shunting goes unrecognised, chronic pulmonary over-circulation will result in damage to the pulmonary vasculature over several decades. A very suggestive combination of findings on the physical examination includes an ejection systolic murmur over the pulmonic area and fixed splitting of the 2nd heart sound (i.e., the second heart sound is widely split and does not exhibit any noticeable variation with respiration). Large defects may manifest as a hyperdynamic precordium with a right ventricular heave. There may also be signs of congestive heart failure (e.g., tachypnea, crackles, hepatomegaly). In adult patients, the pulse may be irregular due to the presence of atrial fibrillation. Echocardiography is the preferred test for establishing the diagnosis. It will show flow between the atria, allow for an assessment of the anatomy, and help in the detection of associated cardiac anomalies. Small secundum type defects (i.e., ≤3 mm) usually close spontaneously; primum and sinus venosus defects do NOT close spontaneously. ECG and chest x-ray changes are NOT needed to make the diagnosis, however there may be several abnormalities present that are worth mentioning. The ECG may reveal evidence of right atrial enlargement, right ventricular enlargement, and a minor right ventricular conduction delay. In regards to axis deviation, the abnormalities present on the ECG depend on the type of defect. With the more common type, ostium secundum, there may RAD, whereas with ostium primum (the type that is common in down syndrome), there may be LAD with left anterior fascicular block. In small-to-moderate sized defects, the chest x-ray will usually demonstrate a normal cardiac silhouette. With larger defects and greater degrees of shunting, there may be several abnormal findings, including a widened heart silhouette, prominent pulmonary vascular markings, and an enlarged pulmonary artery. On the lateral x-ray, hypertrophy and anterior protrusion of the right ventricle can result in a broad area of contact between the anterior wall of the heart and the sternum. Closure is generally NOT required for a small defect in an asymptomatic patient. However, you should counsel the patient, or parent of the patient, to report any symptoms and advise them that they should not participate in certain activities (e.g., scuba diving). Closure should be offered to patients without pulmonary hypertension who are symptomatic, have sustained a paradoxical embolism, or have evidence of right ventricular overload. Large secundum type defects can be closed via catheter intervention if anatomic characteristics are appropriate, while the vast majority of primum and sinus venosus defects require surgical closure. Prophylactic antibiotic therapy is indicated for all patients during relevant procedures (e.g., dental work, bronchoscopy) for at least six months following closure of the defect. Patients who have received an atrial septal occlusion device should also receive antiplatelet therapy (e.g., aspirin alone or in combination with clopidogrel), also for at least six months following closure of the defect. 📺 Subscribe To My Channel and Get More Great Quizzes and Tutorials    / @med4vl   #FOAMed #cardiology #MedEd Disclaimer: All the information provided by Medical Education for Visual Learners and associated videos are strictly for informational purposes only. It is not intended as a substitute for medical advice from your health care provider or physician. It should not be used to overrule the advice of a qualified healthcare provider, nor to provide advice for emergency medical treatment. If you think that you or someone that you know may be suffering from a medical condition, then please consult your physician or seek immediate medical attention.