Atrial Septal Defects: Clinical Case and Viva QnA

Clinical Case of Atrial Septal Defect

A 4-year-old girl is brought to the pediatric cardiology clinic for evaluation of a heart murmur detected during a routine check-up. Her parents report that she occasionally gets tired during play but has no other significant symptoms. There is no history of cyanosis, chest pain, or syncope.

On examination:

• Weight: 16 kg (50th percentile)
• Height: 102 cm (50th percentile)
• Vital signs: HR 100 bpm, RR 22/min, BP 95/60 mmHg
• Cardiovascular: Fixed split S2, grade 2/6 systolic ejection murmur at left upper sternal border
• No cyanosis or clubbing
• Normal peripheral pulses

Investigations:

• Chest X-ray: Mild cardiomegaly, increased pulmonary vascularity
• ECG: Right axis deviation, incomplete right bundle branch block
• Echocardiogram: 15 mm secundum atrial septal defect with left-to-right shunt, mild right ventricular dilation

Based on these findings, the patient is diagnosed with a secundum atrial septal defect. The cardiologist discusses management options with the family, including the potential need for surgical or catheter-based closure of the defect.

5 Varieties of Presentation of Atrial Septal Defects

1. Asymptomatic Presentation:
   • Incidental finding of heart murmur during routine examination
   • No overt symptoms
   • Normal growth and development
2. Symptomatic Presentation in Infancy:
   • Failure to thrive
   • Recurrent respiratory infections
   • Tachypnea and increased work of breathing
   • Signs of congestive heart failure in large defects
3. Exercise Intolerance in Older Children:
   • Reduced exercise capacity
   • Fatigue with physical activity
   • Shortness of breath on exertion
   • Palpitations
4. Paradoxical Embolism:
   • Stroke or transient ischemic attack
   • Systemic embolic events
   • More common in adults but can occur in children
5. Associated Syndromes and Genetic Disorders:
   • Part of a syndromic presentation (e.g., Holt-Oram syndrome)
   • Associated with chromosomal abnormalities (e.g., Down syndrome)
   • May present with features of the underlying genetic disorder along with ASD

VSD Quiz for Medical Students & Professionals

This interactive quiz component covers essential concepts about Ventricular Septal Defects (VSD) in pediatric cardiology. It includes 25 high-yield viva questions with detailed answers

Question 1 of 30

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