Atrial Septal Defects

Question 1

When do ASDs typical present

Answer 1

30s/40s

Question 2

Symptoms of ASD

Answer 2

Palpitations
SOB
Paradoxical emboli
Rt sided HF

Question 3

Signs of ASD (non auscultation)

Answer 3

RV heave
AF
Raised JVP is right sided HF

Question 4

Auscultation of ASD

Answer 4

No murmur associated with defect itself only of consequences of defect.
Functional TR
Flow murmur through pulmonary valve
Fixed splitting of S2 (delay in P2 closure due to increase volume across valve)

Question 5

Associated conditions with ASD

Answer 5

Downs syndrome (low set ears, epicanthic folds, brushfield spots, flat nasal bridge, short inward curling 5th digit_
Holt Oram Syndrome (triphalangeal thumb, radial hypoplasia, flipper appendages, bradycardia)

Question 6

How is severity graded clinically

Answer 6

Small ASD (pulmonary flow murmur)
Large ASD (Pulmonary HTN, functional TR, RV volume overload, AF)

Question 7

Types of ASD

Answer 7

Primum ASD (most common in downs)
Secundum ASD
Sinus venous ASD
Coronary sinus ASD

Question 8

How are ASD investigated?

Answer 8

ECG
CXR
TTE +/- bubble study
TOE
Cardiac catheterisation
Cardiac MRI
Lung biopsy

Question 9

What may you find on ECG in ASDs?

Answer 9

AF
1st degree HB
Primum - LAD
Secundum - RAD

Question 10

Why conduct cardiac catheterisation?

Answer 10

Detection of pulmonary hypertension and its reversibility

Question 11

Who should be surgically managed?

Answer 11

Paradoxical emboli
Symptomatic
Significant shunt
Reversible pulmonary HTN

Question 12

How can ASDs be closed

Answer 12

Open cardiac closure
If secundum percutaneous closure
many cases no surgery required.