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ATRIAL SEPTAL DEFECT ( ASD)

ATRIAL SEPTAL DEFECT
ASD - CF , ETIOLOGY ,PATHO -PHYSIOLOGY, SIGNS & SYM , MANAGEMENT.....ETC

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ATRIAL SEPTAL DEFECT ( ASD)

  1. 1. ATRIAL SEPTAL DEFECT AKSHAY AGRAWAL
  2. 2. CONTENTS 1. Introduction 2. Defination 3. Types 4. Epidemiology 5. Pathophysiology 6. Clinical features 7. Investigations 8. Risk Factors 9. Management
  3. 3. Introduction  Septal defects are more common eg of non cyanotic heart disease. Most common congenital heart disease in adults. Basically it is opening in interatrial septum due to deficiency in septal tissue.
  4. 4. Defination  Holes of variable size in the interatrial septum, atrioventricular ,or Interventricular septum enable blood to be shunted between the left and right sides Of the heart
  5. 5. Types  Ostium secumdum  Ostium primum  Sinous venousus type
  6. 6.  Ostium Secumdum - It occurs in central portion of septum.  Ostium Primum -It occurs immediately above AV valves and often associated with CLEFT in anterior valve leaflet .  More common In females.  Sinous Venosus Type-It occurs near orifice of superior vena cava And often associated with anomalous pulmonary venous drainage .
  7. 7. Epidemiology Male : Female = 1:2 Most commonly seen in children
  8. 8. Pathophysiology  In ASD the right atrium not only receives blood from SVC and IVC but also from left atrium and is enlarged in size .  Pulmonary vascular resistance which is low or normal at childhood goes as high up as the patient reaches 3rd or 4th decade giving rise to pulmonary hypertension .
  9. 9.  As hypertension increases the initial left to right shunt reverses to right to left shunt - EISENMENGER SYNDROME.  The patient may develop right heart failure or atrial fibrillation
  10. 10. Clinical Features  Dyspnoea Chest Infection Cardiac Failures Arrhythmias
  11. 11. Visible and palpable Right Ventricle 1st heart sound and split with Tricuspid component Wide fixed splitting of S2 Systolic thrill if loud murmur Ejection Click
  12. 12. Murmurs • Pulmonary ejection systolic murmur – Increased pulmonary flow • Tricuspid murmur – is heard over left sternal edge louder on inspiration • Graham-Steell murmur – of pulmonary regurgitation if pulmonary hypertension
  13. 13. • Late systolic murmur – occurs in Ostium secundum • Murmur of mitral incompetence – in Primum defect  Small peripheral pulse – due to reduced Left Ventricular output.
  14. 14. Investigations Chest X-ray Prominent pulmonary artery can be seen and traced upto diaphragm , end on view of pulmonary artery is seen as white dots. ASD also reveals - mild to moderate cardiomegaly - prominent right atrium and right ventricle
  15. 15. ECG Right axis deviation in 85% of cases Left axis deviation and prolonged PR interval seen in ostium primum Right Atrial enlargement
  16. 16. Mild right ventricular hypertrophy Inverted P waves in Sinous Venosus type Right Bundle Branch Block is seen which is partial or complete
  17. 17. Complete heart block may be revealed in ostium primum type Large ASD may have prolonged PR interval
  18. 18. Echocardiogram Reveals enlarged right ventricles with paradoxical septal motion
  19. 19. Management: I. Medical Prompt treatment of respiratory tract infections. Antiarrhythmic medications for atrial fibrillation and supraventricular tachycardia that includes qunidine , procainamide and flucaniamide. Usual measures for hypertension , coronary disease and heart failure.
  20. 20.  Surgical Usually with a patch of pericardium or a prosthetic material or Percutaneous tanscatheter device is used for closure of the defect.
  21. 21. THANK YOU

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