Atrial septal defect and Variants: Clinical Pearls
- ASD with non significant shunt
A= V
RV apex
ESM at P area
WFS S2 - ASD significant shunt
V>>A
WFS S2
MDM at Tricuspid area
Features of pah
Rarely a thrill in P area - ASD with Eisenmenger
Cyanosis
Clubbing
PSH grade 3 as supra system RV pressure
Prominent JVP same reason
ESM May be there
RV apex
Cardiomegaly
PR murmur
Ejection click
Rarely a thrill( usually absent) - ASD with cyanosis
- Elevated pulmonary artery pressure and pulmonary vascular resistance
- Eisenmenger syndrome
- Normal or mildly elevated pulmonary artery pressure
- Anomalies of systemic venous drainage
- Anomalies of connection
- Straddling of SVC or IVC in sinus venous ASD
- Abnormal streaming of IVC blood (prominent Eustachian valve) or TR jet
- Anomalies of systemic venous drainage
- Elevated right atrial pressures
- Right atrial myxoma
- Right ventricular infarction
- Severe pulmonary stenosis and right ventricular hypertrophy
- Mechanical ventilation with increased pulmonary end-expiratory pressure
- Platypnea-orthodoxya syndrome
- Elevated pulmonary artery pressure and pulmonary vascular resistance
- ASD with thrill
ASD with lutembacher
Asd with PS
Asd with papvc
Large ASD - ASD with PS
Thrill prominent
Second heart sound soft
Delayed peaking of PS murmur and longer murmur
Click +
Finding of RVH prominent
RV apex
JVP prominent a wave - ASD with lutembacher
MS with non restrictive ASD
Finding of orthopnea and PND less
Loud S1
Murmur less prominent
OS and Presystolic accentuation still be present
More severe pah compared to MS alone
Thrill in pulmonary area
Ejection murmur pulmonary area
