Cardiovascular · Year 1 · from Cardiovascular

Case 3: Atrial Septal Defect Discovered in Adult

Patient Presentation

Demographics: 35-year-old female

Chief Complaint: Palpitations and exercise intolerance

History of Present Illness: A 35-year-old female presents with a 2-year history of progressive exercise intolerance and palpitations. She notes becoming short of breath when climbing stairs and during aerobic exercise. She has had occasional episodes of rapid heartbeat. She has no prior cardiac history and was previously athletic.

Physical Examination:

  • Vital Signs: BP 115/70 mmHg, HR 85 bpm (irregular), RR 16/min, SpO2 97% on room air
  • General: Thin female in no acute distress
  • Cardiovascular:
  • Fixed split S2 (does not vary with respiration)
  • Grade 2/6 systolic ejection murmur at left upper sternal border (pulmonary flow murmur)
  • RV heave palpable
  • Lungs: Clear

Workup

  • ECG: Right axis deviation, incomplete RBBB pattern, atrial fibrillation
  • Chest X-ray: Enlarged right atrium and right ventricle, prominent pulmonary arteries
  • Echocardiogram:
  • Secundum ASD (2.2 cm) with left-to-right shunt
  • Dilated right atrium and right ventricle
  • Qp:Qs ratio 2.5:1
  • Estimated PA systolic pressure 45 mmHg

Diagnosis

Secundum atrial septal defect with right heart volume overload and secondary atrial fibrillation

Anatomical Correlation: The interatrial septum develops from the septum primum and septum secundum. The foramen ovale is formed between these structures. A secundum ASD occurs due to excessive resorption of septum primum or inadequate development of septum secundum, resulting in a defect in the fossa ovalis region. The left-to-right shunt causes chronic RV volume overload leading to chamber dilation.

Treatment

  1. Rate control for atrial fibrillation (beta-blocker)
  2. Anticoagulation for atrial fibrillation
  3. Percutaneous transcatheter ASD closure (suitable for secundum defects with adequate rims)
  4. Post-closure monitoring for resolution of RV dilation

Clinical Image

Image Description: Echocardiogram (subcostal view) demonstrating an atrial septal defect with color Doppler showing left-to-right shunt flow across the interatrial septum from left atrium to right atrium.

Source: Radiopaedia - Atrial septal defect License: CC BY-NC-SA 3.0 URL: https://radiopaedia.org/cases/atrial-septal-defect-asd-secundum

All cases for this lecture as Markdown