Internal Medicine

P1: SBT

0521779407-05 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:49

Atrial Premature Complexes Atrial Septal Defect (ASD) 195

follow-up

■Holter to ascertain effectiveness of treatment.

complications and prognosis

■Can be precursor of atrial fibrillation or flutter.

Atrial Septal Defect (ASD)..............................

MARIA ANSARI, MD

history & physical

History

■Sinus Venosus (defect in superior portion of atrial septum)

➣Associated with partial anomalous pulmonary venous return

■Ostium secundum (defect in central portion of atrial septum)

➣Most common adult congenital heart disease after bicuspid aor-

tic valve

➣Females: Males 2:1

➣Mitral valve prolapse present in up to 1/3

■Ostium primum (defect in lower portion of atrial septum)

➣Associated with clefts of AV valves, particularly MV cleft or regur-

gitation

Signs & Symptoms

■May not be symptomatic until age 40–50

■Symptoms of heart failure with exertional dyspnea may develop

■Atrial arrhythmias, especially atrial fibrillation are common

■Rarely cyanosis develops when there is shunt reversal (right-to-left)

■RV lift, palpable PA, fixed split S2 with mid systolic murmur

■Ejection click is common

tests

Screening

■Physical exam

Imaging

■EKG

➣Ostium primum: RSR’ on EKG with LAD and 1st degree AVB in

75% of cases

➣Ostium secundum: rsR’ or RSR’ in V1 common with RAD

■Transthoracic echocardiogram