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Atrial Septal Defect is a congenital heart disease
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Case ReportATRIAL SEPTAL
DEFECTPresented by:
ANDI DEWI PRATIWIC111 11 153
Supervisor:dr. Akhtar Fajar M, Sp.JP, FIHA
Cardiology and Vascular Medicine DepartmentMedical Faculty of Hasanuddin University
Makassar2015
PATIENT’S IDENTITY
Name : Ms. JAge : 22 years oldSex : FemaleAdmission date : August 8th, 2015Medical record : 699600
HISTORY TAKING
Chief complaint: shortness of breath
• Suffered since 3 months before admission• Orthopneu (-), dyspneu on effort (+), paroxysmal nocturnal
dyspneu (-)• Palpitation (+)• Chest pain (+), intermittently, not radiating down the arm• Fatigue (+)• Fever (-) cough (-) headache (-) epigastric pain (-) nausea &
vomiting (-)• Urination & defecation normal
HISTORY TAKING
• History of outpatient in Wahidin Sudirohusodo Hospital 3 months ago because of goiter
• History of previous shortness of breath (-)• History of chest pain (-)• History of hypertension (-)• History of diabetes mellitus (-)• History of smoking (-)• History of heart disease in family (-)
RISK FACTOR
Modifiable
-
Non modifiable
Gender : female
History of alcohol, drugs, or illness of
mother during pregnancy (-)
history of family with
same disease (-)
Histrry of family with other
kongenital disease (-)
PHYSICAL EXAMINATION
• Moderate illness• Under-nourished• Compos mentis
General
state• BP: 110/80 mmHg• HR: 78/i• RR: 22x/i• Temp: 36,5oC
Vital signs
• Anemic (-) icterus (-) cyanotic (-)
• DVS R+2 cmH2o• Thyroid enlargement , grade
IB
Head & neck
PHYSICAL EXAMINATION
THORAX
• I: symmetric, normochest
• P: tumor mass (-) tenderness (-)
• P: sonor, pulmo-hepar border : 6th ICS ant. dextra
• A: vesicular, ronkhi (-) wheezing (-)
COR
• I : apex cordis not seen
• P: apex cordis not palpable
• P : dull, left border : ICS V linea midclavicularis sinistra
• A : S1/S2 regular, systolic ejection murmur in ICS II sinitra
PHYSICAL EXAMINATION
ABDOMEN
• I: convex, symmetric, following breath movement
• A: peristaltic (+), normal
• P: tenderness (-), tumor mass (-), hepar and spleen not palpable
• P: tympani(+), ascites(-)
EXTREMITIES
• Edema -/-
ELECTROCRADIOGRAPHY (15/8/2015)
INTERPRETATION• Rhytm : Sinus• Heart rate : 94x/i• Regularity :
regular• Axis : Right
Axis Deviation• P wave : 0,08 sec• PR interval : 0,20
sec• QRS complex : RsR’
morphology in lead V1, III, V3, AVL, R wave is taller than S wave in lead V1
• ST segment : normal
• T wave : normalCONCLUSION:Sinus rhytm, HR 94 x/min, right axis deviation with incomplete
RBBB, right ventricle hipertrophy/dilatation
CHEST X-RAY (6/8/2015)
- Lung bronchovascular marking increased.
- Cor difficult to assess, the impression enlarged. Heart waist prominent, elevated apex (RVE), normal aorta
- Both sinus and diaphragm well
- The bones intact
Conclusion :Cardiomegaly with signs L to R shunt
Lab Value Unit
WBC 5,1 (10³/UI)
RBC 4,71 (106/UI)
HGB 12,1 (gr/dL)
HCT 36,2 %
PLT 212 (103/uL)
PT 11,9 Second
APTT 28,4 Second
INR 1,11 -
FT4 2,71 ng/dl
TSHS <0,05 mlU/ml
Lab Value Unit
GDS 85 mg/dL
Ureum 19 mg/dL
Creatinin 0,5 mg/dL
SGOT 18 u/L
SGPT 19 u/L
Natrium 142 mmol/L
Kalium 3,9 mmol/L
Klorida 111 mmol/L
LABORATORY RESULT (1/8/2015)
TRANSTHORACIC ECHOCARDIOGRAM
(21/5/2015)
CONCLUSION
• ASD secundum enlarged with left to the right shunt
• Moderate Pulmonary hypertension
• Dilatation the right atrium and right ventricle
TRANSESOPHAGEAL ECHOCARDIOGRAPHY
(21/5/2015)
CONCLUSION
secundum ASD
SECUNDUM ATRIAL SEPTAL DEFECT WITH MODERATE PULMONARY HYPERTENSION
DIAGNOSIS
ATRIAL SEPTAL DEFECT CLOSURE WITH AMPLATZER SEPTAL OCCLUDER
TREATMENT
SYMPTOMATIC TREATMENT (DIURETIC, BERAPROST SODIUM)
ATRIAL SEPTAL DEFECT
DEFINITION
Atrial septal defect (ASD) is a congenital heart defect in which
persistentopening in the interatrial septum
allows direct communication between the left and right atria.
EPIDEMIOLOGY
Incidence : ASD occur on 1 by 1500 live birth.
ASD occurs with a female-to-male ratio of approximately 2:1
Secundum ASD account for75% of all ASDsand 30% to 40% of congenital disease seen in patients older than 40 years
CLASSIFICATION
Type ASD
Secundum ASD
Sinus Venosus
ASD
Primum ASD
• mutation in gen cardiac transcription factor NKX2.5
Etiology
• Prenatal factor• Genetic factor
Risk Factor
PATOPHYSIOLOGY
CLINICAL MANIFESTATION
palpitation
dyspnea on exertion
fatigue
Chest pain
recurrent lower respiratory tractinfections
Pathomechanism of Symptoms Dyspnea
Long Standing L to R shunt
Hypervascularization of pulmonary circulation
Vascular bed filled with blood
Pulmonary hypertension
and Hydrostatic
pressure elevated
Transudation of fluid from capillary to interstitial
Inhibition of diffusion O2 on lung
Dyspnea
Fatigue
Pathomechanism of Symptoms
L to R shunt
Volume systolic
of LV decreas
e
Blood containi
ng oxygen decreas
e
Perfusion
decrease
Ischemic and
metabolism
disorder
Fatigue
Pathomechanism of Symptoms
Angina
Systemic circulation decrease
Coronary circulation decrease
Right volume overload
Pulmonary hypertension
Wall-Stress increases of RV
Oxygen demand increase-Oxygen supply decrease
Angina
Pathomechanism of Symptoms
Palpitation
Left to Right Shunt
Dilatation of right atrium
and right ventricle
Prolonged of conduction pathway
re-entry current
Atrial Fibrillation/ SVT/ PAT
Palpitation
Pathomechanism of Symptoms Recurrent of respiratory tract infection
Hypervascularization of pulmonary
circulation vascular bed filling
Hydrostatic pressure increases
Edema of lower respiratory tract
disruption of immunity system
susceptible of infection
DIAGNOSIS
Cardiac
catheterizatio
n
Echocardiography
Chest X-
Ray
ECG
Physical exa
mination
History taking
EXAMINATION
PHYSICAL EXAMINATION
• Thrill can be palpated• Cardiomegaly in percussion• The second heart sound (S
2) demonstrates a widened (wide fixed splitting)• systolic murmur at the upper-left
sternal border• A mid-diastolic murmur may also
be present at the lower-left sternal border
ECG
• Right atrial deviation• RBBB• RVH• Abnormal P wave
ECHOCARDIOGRAPH
• septal defect location• the direction of the shunt• the size of the atrium and right ventricle• mitral valve involvement
CXR
• Cardiomegaly• Right atrial dilatation• Bronchovascular marking prominent
CARDIAC CATHETERIZATION
• see the oxygen saturation in the right atrium, measuring the magnitude ratio of pulmonary flow and systemic• set the pressure and pulmonary artery resistance• evaluating pulmonary artery anomaly
COMPLICATION
PULMONARY
HIPERTENSION
ARITMIA RIGHT-SIDED HEART FAILURE
EISENMENGER SYNDROME
TREATMENT
SYMPTOMATICDEFINITIVE
DEFINITIVE TREATMENT
SURGERYINTERVENTIONAL
INTERVENTIONAL
AMPLATZER SEPTAL OCCLUDER
REFERENCES
1. Manurung D. Defek Septum Atrial. In: Sudoyo A, Setiyohadi B, Alwi I, Simadibrata M, Setiati S, editors. Buku Ajar Ilmu Penyakit Dalam. V ed. Jakarta: Interna Publishing; 2009. p. 2. Braunwald, Eugene et al. Braunwald's Heart Disease A Textbook Of Cardiovascular Medicine. Elsevier. 2015.3. Lilly Leonard S. Pathophysiology of Heart Disease. Wolters Kluwer. 5th edition. 2011. 4. Rilantono, Lily Ismudiati. Buku Ajar Kardiologi. Jakarta : Fakultas Kedokteran Universitas Indonesia. 2004.5. Topol Eric J. Textbook of Cardiovascular Medicine. Lippincott Williams & Wilkins. 2nd Edition. 2002.
THANK YOU
SIRKULASI DARAH JANIN
Patent Foramen Ovale VS ASD
