Congenital Heart Defects - Atrial Septal Defect

Question 1

Epidemiology

Answer 1

Females
Most common CHD in adults

Question 2

Risk factors

Answer 2

Down syndrome
Assosciated with ostium primum defects
Foetal alcohol syndrome

Question 3

Types of ASD

Answer 3

• Ostium secondum = where the septum secondum failst to fully close
• Patent foramen ovale = where the foramen ovale, fails to close (although this is not strictly classified as an ASD)
• Ostium primum = where septum primum fails to fully close. This tends to leave to atrioventricular valve defects making it an atrioventricular septal defect

Question 4

Signs

Answer 4

Cyanosis
Mid - systolic, crescendo-decrescendo murmur loudest at the upper left sternal border
Splitting S2 sound due to pulmonary valve closing after the aortic valve

Question 5

Symptoms

Answer 5

Can be asymptomatic in childhood and first presentation in adulthood can sometimes be STROKE or HF
Difficulty feeding
Poor weight gain
Lower resp tract infections
Difficulty feeding
Dyspnoea

Question 6

Diagnosis

Answer 6

FIRST LINE= Transthoracic Echo - preference in children
TOE = adults
CXR = large pulmonary arteries + cardiomegaly
ECG = may show RBBB due to right ventricle dilation.

Question 7

Management

Answer 7

Small = watch + wait
Large = surgical correction using trans venous catheter closure (via femoral vein) or open heart surgery

Question 8

Complications

Answer 8

Stroke
- Anticoagulation (aspirin, warfarin + NOACS) reduce risk of clots and stroke in adults
A.fib
Atrial flutter
Pulmonary hypertension and RSHF
Eisenmengers syndrome = pul HTN causes reversal of shunt, now R-L and O2 blood pumped systemically