PEDS Mod 3

Question 1

ESSENTIALS OF DIAGNOSIS & TYPICAL FEATURES

Fixed, widely split S2, RV heave.

Grade I–III/VI systolic ejection murmur at the pulmonary area.

Large shunts cause a diastolic flow murmur at the lower left sternal border (increased flow across the tricuspid valve).

ECG shows rsR′ in lead V1.

Frequently asymptomatic.

Answer 1

ASD

Question 2

Which ASD is most common?

Answer 2

Foramen secundum

Question 3

Ostium secundum ASD occurs in 10% of patients with congenital heart disease and is two times more common in females than in males. The defect is most often ______ but may be familial or have a genetic basis (Holt-Oram syndrome). After the third decade, atrial arrhythmias or pulmonary vascular disease may develop. Irreversible _______ _______ resulting in cyanosis as atrial level shunting becomes right-to-left and ultimately right heart failure can occur and is a life-limiting process (Eisenmenger syndrome).

Answer 3

Ostium Secundum ASD occurs in 10% of patients with congenital heart disease and is two times more common in females than in males. The defect is most often sporadic but may be familial or have a genetic basis (Holt-Oram syndrome). After the third decade, atrial arrhythmias or pulmonary vascular disease may develop. Irreversible pulmonary hypertension resulting in cyanosis as atrial level shunting becomes right-to-left and ultimately right heart failure can occur and is a life-limiting process (Eisenmenger syndrome).

Question 4

Most infants and children with an ASD have _______ symptoms. Older children and adults can present with…. The direction of flow across the ASD is determined by the compliance of the ventricles. Because the right ventricle is normally more compliant, shunting across the ASD is ______ as blood follows the path of least resistance. Therefore, cyanosis does not occur unless RV dysfunction occurs, usually as a result of pulmonary hypertension, leading to reversal of the shunt across the defect.

Answer 4

Most infants and children with an ASD have no cardiovascular symptoms. Older children and adults can present with exercise intolerance, easy fatigability, or, rarely, heart failure. The direction of flow across the ASD is determined by the compliance of the ventricles. Because the right ventricle is normally more compliant, shunting across the ASD is left-to-right as blood follows the path of least resistance. Therefore, cyanosis does not occur unless RV dysfunction occurs, usually as a result of pulmonary hypertension, leading to reversal of the shunt across the defect.