questions 3

Atrial Septal Defects

Topic updated on 01/04/16 2:14pm

Snap Shot
  • A 6-year-old girl is referred to a cardiologist for an evaluation of a heart murmur. She is healthy and has reached all developmental milestones. On exam, the precordium is hyperdynamic with a prominent right ventricular heave. A soft murmur is present in the pulmonic position (LUSB), and the second heart sound has persistent splitting during inspiration and expiration.
  • Characterized by hole in the atrial septum
    • most commonly due to patent foramen ovale 
  • 2nd most common congenital heart lesion
    • VSD is most common
    • association with Downs syndrome and fetal alcohol syndrome
  • Predisposes patient to
    • CHF
      • 2nd/3rd decades of life
    • stroke
      • due to paroxysmal embolus
        • note: can also be seen with VSD
    • may lead to Eisenmenger's syndrome
      • pulmonary hypertension 
      • right ventricular hypertrophy
      • reversal to a right-to-left shunt
  • Symptoms
    • asymptomatic in youth
      • often discovered on routine school health exams
    • mild fatigue
    • frequent respiratory infections
  • Physical exam
    • midsystolic ejection murmur
      • ↑ flow through pulmonary valve
    • diastolic rumble
      • ↑ flow across tricuspid
      • ASD does not directly cause a murmur because there is no pressure gradient across it
      • can progress to louder diastolic murmur due to pulmonic regurgitation if pulmonary artery dilates
    • loud S1
    • wide fixed-split S2 


Qbank (2 Questions)

(M1.CV.75) A 7-year-old girl is referred to a pediatric cardiologist after a heart murmur was auscultated during a routine school health examination. The patient has not experienced any symptoms of shortness of breath, fatigue, chest pain, or palpitations. She is healthy, does not have any significant medical history, and had an uneventful birth without any complications. Her vital signs are as follows: T 37.2 C, HR 92, BP 104/62, RR 24, SpO2 99%. Physical examination is significant for a midsystolic ejection murmur heard best at the 2nd intercostal space near the left sternal border, a loud S1 heart sound, a widely fixed split S2 heart sound, and no evidence of cyanosis or clubbing. An echocardiogram is conducted and reveals a left-to-right shunt across the interatrial septum. Surgical correction of this patient's condition will most likely prevent which of the following from developing later in life? Topic Review Topic

1. Arteriovenous fistula
2. Pulmonary stenosis
3. Coronary artery disease
4. Pulmonary hypertension
5. Aortic root dilation

(M1.CV.149) A 32-year-old woman presents to the emergency department with 2 hours of left-sided weakness. Her husband reports that she had been complaining of pain and swelling in her right calf for several weeks prior to this event. The couple had recently returned from a vacation in Europe. What ausculatory finding would explain the mechanism by which her more recent complaint occurred? Topic Review Topic

1. Holosystolic murmur radiating to the axilla
2. Wide, fixed splitting of S2
3. Crescendo-decrescendo murmur heard loudest at the left second intercostal space
4. Holosystolic murmur that increases on inspiration
5. An S2 that splits during expiration

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