Atrial septal defect- Case Presentation by Mrunalini Patil Acyanotic congenital heart disease Cardiovascular system

1. Mrunalini Patil
Roll no: 183

2. § Name: Mahadevi Koli
§ Age: 40 years
§ Sex: Female
§ Occupation: Housewife
§ Marital status: Married
§ Religion: Hindu
§ Address: Peeranwadi

3. § Recurrent palpitation since childhood
§ Recurrent breathlessness since childhood
§ Recurrent swelling of body since childhood
§ Chest pain for last 4 months
§ Admitted for cardiac evaluation which was required before
cholelithiasis operation

4. According to the statement of the patient , she has been suffering
from recurrent palpitation since childhood. It aggravated on
exertion and relieved by rest.
She did not give any H/O heat intolerance, weight loss and
diarrhoea.
She also complains of recurrent breathlessness since childhood. It
aggravates on lying flat and she feel comforts on sitting position.
Occasionally, she experiences nocturnal breathlessness, usually at
late hours of night, for which she has to get up from sleep, walk
and take deep breath to be comfortable. It is not associated with
cough. It is not associated diurnal or seasonal variation.
There is no history of exacerbation on exposure to dust, cold or
other allergen.

5. She also gives the H/O recurrent swelling of whole body which was
first appeared on the leg then spread all over the body. It was not
associated with any change of volume and color of urine.
She did not give any history of jaundice, bloody vomiting , black
tarry stool.
Swelling aggravated at the end of the day and relieved by taking
medication which was associated with increased urination but she
could not mention the name.
She also complains of chest pain for last 4 months which is
retrosternal, compressive in nature radiates to back, aggravates on
exertion and relieved by rest.She also complains of generalized
weakness and fatigue for last one month which is gradually
increasing.

6. She did not give any H/O loss of consciousness, syncope,
hoarseness of voice, difficulty in swallowing, skin rash.
She gave no history of joint pain or abnormal movement of the
body. On query she give the history of recurrent fever and
cough at her childhood.
She also mentioned that four months back she was diagnosed
with cholelithiasis, for which she advised for cholecystectomy,
though she did not have any abdominal pain. She at first went to
general surgery department for operation but the surgeon
referred her to cardiology department for cardiac evaluation.

7. She gave h/o several visits to local doctor due to breathlessness
and she was told that she had some cardiac abnormality. But she
could not mention the name.
She did not give any history suggestive of rheumatic fever.
She is not a k/c/o DM, HTN, asthma, TB
No h/o previous surgery or hospitalisation or previous blood
transfusion

8. § No history of similar complaints in the family
§ Nothing contributory

9. § Diet- Mixed
§ Sleep- Disturbed
§ Apetitie- normal
§ Bowel and Bladder- Normal and regular
§ Habits- Nil

10. She took some medication for body swelling which was
associated with increased urination but she could not name of
drugs.

11. § Para 5: All were normal vaginal delivery
§ She attained menopause last year
§ She gives history of increased breathlessness during her last
pregnancy.

12. § The patient is a 40years old female who is moderately built and
moderately nourished. He is conscious, cooperative and well
oriented to time ,place and person .
§ Height – 165cm
§ Weight – 53 kg
§ BMI- 19.5 kg/m2
§ Vitals:
§ Pulse rate – 68 bpm
§ Respi rate – 20 cpm
§ BP – 110/70mmhg
§ Temp - afebrile
§ Pallor – present
§ Icterus – Absent
§ Clubbing –Absent
§ Cyanosis – Absent
§ Lymphadenopathy - Absent
§ Oedema- pitting type

13. 1. Scalp : black lustrous hair non pluckable
2. Eyes : pallor present and Icterus not present, no ptosis no
nystagmus
3. Nose: normal appearance
4. Ears: external pinna and canal normal
5. Oral cavity: no angular stomatitis, teeth and gum are normal,
tongue not deviated, uvula - central
6. Face: normal appearance
7. Neck: no rigidity, no lymphadenopathy, no thyroid
enlargement

14. 8. Upper limb: Nail: Clubbing present, Grade 3
No Lymphadenopathy
9. Chest and abdomen: Normal
10. Lower limb: Nails: Normal
No Lymphadenopathy
Oedema is present bilaterally, pitting type
11. Back – normal
Inference: Normal head to toe examination

15. CARDIOVASCULAR SYSTEM

16. § Pulse-
§ Rate: 68 beats/min
§ Rhythm: Regular
§ Volume: Low volume
§ Condition of vessel wall: Elastic
§ Character of pulse: normal
§ Radio-radial comparison: No delay
§ Radio- femoral comparison: No delay bilaterally

17. § Peripheral pulses:
Right Left
Dorsalis Pedis Palpable Palpable
Posterior tibial Palpable Palpable
Femoral Palpable Palpable
Brachial Palpable Palpable
Carotid: Systolic
thrill in carotids is
felt (Carotid
shudder)
Palpable Palpable

18. § Signs of Congestive cardiac failure:
Jugular Venous pressure: not raised
Liver: not palpable
Dependent Edema:present
Hepatojugular reflux: absent
§ Blood Pressure: 110/70 mm of hg in left upper arm in supine position
§ Signs of infective endocarditis not seen
Pallor: Present
Clubbing: Present in Upper limbs- Grade 3 clubbing
Temperature: afebrile
Spleen: not palpable
No petechiae, osler nodes, Janeway’s lesion

19. Inspection
§ Precordial bulge- Absent
§ Apical Impulse- Seen in the Left 5th Intercostal space just
medial to mid clavicular line
§ Pulsations other than apical impulse : not visualised

20. Palpation
§ Precordial tenderness - absent
§ Apex Beat: Left 5th Intercostal space just medial to mid clavicular
line(9cm from midsternal), normal in character
§ Left Parasternal Heave: Absent
§ Epigastric Pulsations: not felt
§ Diastolic Shock: Absent
§ Supraclavicular pulsations: not felt
§ Thrills:
§ In Tricuspid area- systolic thrill is present, best felt in inspiration
§ Thrill is also present in pulmonary area

21. Percussion
§ Right border: Retrosternal
§ Left border: along the apex
§ Left 2nd space: resonant note
§ Sternum upper and lower: Dull note

22. vMitral Area:
§ Heart sounds: S1 heard
vTricuspid Area
§ Heart Sounds: masked by the systolic murmur
§ Murmur: systolic murmur, throughout systole, associated with thrill-
Grade 4 murmurs, high pitched, no conduction, best heard in inspiration
with the diaphragm
§ 2nd heart sound is widely split and fixed.
vPulmonary Area
§ Heart sounds: P2 heard
§ Murmur : ejection systolic murmur is heard in left 2nd and 3rd intercostal
space radiating to left side of neck, grade 4 /6..
vAortic area
§ Heart sounds: A2 heard
§ No added sounds heard in any area

23. Respiratory System:
§ NVBS heard
§ No adventitious sounds
Central nervous system:
§ Conscious and well oriented
§ Mental functions- intact
Per abdominal system:
§ Normal bowel sounds heard
§ Appears normal and non tender

24. Acyanotic congenital heart disease s/o atrial septal defect
associated with tricuspid regurgitation

25. § ASD with pulmonary stenosis
§ Ventricular septal defect
§ Partial anomalous pulmonary venous connection
§ Pulmonary stenosis