atrial septal defec - creighton university · asd fun facts {accounts for 5-10% of congenital heart...
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Atrial Septal Defects
Melanie Norton
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ASD Fun Facts
Accounts for 5-10% of congenital heart defects (6-8:1000 live births)
Symptoms not often seen in infancy or early childhood
Often not correctly identified until later in life
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Cardiac Looping
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Atrial Septation
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Atrial Septation
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Atrial Septation
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Three Common Types of ASD
Ostium Secundum Atrial Septal Defect
Ostium Primum Atrial Septal Defect
Sinus Venosus Atrial Septal Defect
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Ostium Secundum Atrial Septal Defect
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Ostium Primum Atrial Septal Defect
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Sinus Venosus Atrial Septal Defect
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Case Study
6 year old girlCardiac murmur detected at 4 years of ageGrowth and development slightly retardedSome limitation of exercise toleranceNo cyanosis or clubbingIncrease in the number of respiratory infections between the ages of 4 and 6 years
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Physical Examination
Slight asymmetry of the thoraxProminence of the precordiumHeart not markedly enlargedNo palpable thrills Systolic murmur audible along left sternal border
Max. intensity heard in the 2nd left intercostal space
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Sounds of the Heart
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Physical ExaminationElectrocardiogram showed right axis deviation and incomplete right bundle branch blockCardiac catheterization verified the diagnosis
Information about size and location of defect
Fluroscopic exam dilation of right heart and pulmonary arteriesPulsation of pulmonary artery branchesIncreased vascularity of the lung fields
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Diagnosis
Atrial septal defect – ostium secundum type
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Causes of Atrial Septal DefectsUnclear
Chance 2:1 prevalence in female vs. male Rubella (German measles)DiabetesMedications
Isotretinoin (accutane)Lithium (eskalith) Alcohol
HeredityAppear to run in families1/3 children with Trisomy 21 also have a heart defect
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Symptoms
FatigueSweatingRapid or difficulty breathingShortness of breathTiring easily when playingPoor growthFrequent respiratory infections
*Often resemble other conditions or medical problems
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Diagnostic Tests - Echocardiogram
Images from http://www.kumc.edu/kumcpeds/cardiology/asddfct.html
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Other Diagnostic Tests –
Chest X-RayElectrocardiogram (ECG)Cardiac CatheterizationMRI
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Other Problems Associated with ASD
Right atrial and ventricular enlargementTricuspid regurgitationPulmonary hypertensionRhythm disturbancesStroke
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Treatment
Recommended that the ASD is treated during childhoodTreatment of ASD depends on severity of the defect on the heartFour treatment options
Observation and MonitoringHolter Monitor
Medical ManagementSurgery Non-surgical closure (new)
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Holter Monitor
Images from http://www.centipedia.com/articles/Holter_monitor, http://www.nlm.nih.gov/medlineplus/ency/imagepages/8810.htm, & http://www.thirtyfour.com/colin/photos3.html
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Non-surgical Closure - Occluder
Images from http://www.mhs.net/Articles/Editions/26/AtrialSeptalDefect.aspx & http://www.mayoclinic.org/atrial-septal-defect/asddevice.html
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Sources
Abdulla, Abdulla M. (2006). Holter Monitor. http://www.heartsite.com/html/holter.html#what.A.D.A.M., Inc. (2005) Holter Heart Monitor. http://www.nim.nih.gov/medlineplus/ency/imagepages/8810.htm.Dr. Brauer’s class notes.Mayo Foundation for Medical Education and Resaerch (2005). Treatment of Atrial Septal Defect at Mayo. http://www.mayoclinic.org/atrial-septal-defect/index.html.Milleman, John T. B.S.; Caldarone, Christopher A. M.D.; Fagan, Thomas M.D. (2000). Placement of CardioSEALOcculder.http://www.vh.org/pedictric/pr.../SurgicalCHD/ASD?Figure06.html.Schwartz, Seymour M.D. (2005). Schwartz’s Principles of Surgery. McGraw Hill.Smith, Maggie. (2005) Atrial Septal Defects.Variety Children’s Heart Centre. Closure of Atrial Septal Defects.http://home.cc.umanitoba.ca/~soninr/ASDClosure.html.