Atrial septal defect history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, M.B.B.S. [[2]]; Cafer Zorkun, M.D., Ph.D. [3]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [[4]]
Overview
The development of symptoms associated with atrial septal defect relates to the size and severity of intracardiac shunting of blood across the defect. A large atrial septal defect will result in the presentation of symptoms at a younger age. However, smaller, less severe defects may be asymptomatic until adulthood. Common symptoms include: heart failure, heart palpitations, fatigue, and recurrent respiratory infections.
History
Atrial septal defects can be asymptomatic for the beginning of a patient's life. Less severe defects can be undetected during examination and present subtle symptoms, if at all.
Symptom onset can occur gradually as patients age and the defect becomes more influential on the heart's functioning. Often, additional complications may develop such as pulmonary arterial hypertension, mitral valve diseases, and arrhythmias (specifically atrial arrythmia). Clinically, patients will almost always present symptoms by the sixth decade of life.
As patients age, the deterioration of the heart's mechanisms may cause:
- Atrial arrhythmias like atrial fibrillation, atrial flutter, paroxysmal atrial tachycardia, this historically is seen in the fourth decade of life and becomes a symptomatic precursor for ultimate right ventricular failure
- Age-associated deductions in hemodynamic flow left ventricle resulting in left-to-right shunting of blood
- Pulmonary aterial hypertension, as a result of such left-to-right shunting, causing right ventricle strain from volume and pressure overloading
- Mitral regurgitation/mitral valve insufficiency resulting in higher pressure in the left atrium and an increase in shunting of blood from left-to-right
Pediatric Symptoms
In the majority of patients, infancy and adolescence tend to be asymptomatic. However, if the atrial septal defect is large enough, the intracardiac shunting of blood will allow such a disruption in hemodynamics that symptom onset occurs.
- Common symptoms of a large ASD include:
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- Poor growth/failure to thrive (associated with extracardiac pathology)
- Dyspnea with exertion/exercise
- Fatigue
- Recurrent respiratory infections
- Less common symptoms:
- Associated cardiac disorders
- Pulmonary disorders
- High blood pressure
- Atrial arrhythmias
Adult Symptoms
Onset of atrial septal defects can be directly influenced by the size of a defect, often presenting asymptomatically earlier on in a patient's life as a direct result of a smaller defect. Smaller defects cause less hemodynamic disruptions. As a person ages, the potential for the development of symptoms increases. Adults, especially those over the age of 40, will become symptomatic. Nearly all adults with an atrial septal defect will present with symptom onset by the age of 60.
- Common symptoms include:
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- Elevated jugular venuous pressure
- Atrial arrhythmias
- Exercise intolerance
- Dyspnea
- Fatigue
- Less common symptoms include:
- Left ventricular dysfunction
- Stroke due to paradoxical embolization
- Migraine
- Eisenmenger syndrome
- Cyanosis
Rapidity of Symptom Onset
Atrial septal defect patients are often asymptomatic until later in life. The majority of people with atrial septal defects may not experience any symptoms until after the age of 40. Nearly all atrial septal defect patients will manifest symptoms by the age of 60. Symptoms may become more rapid in onset as patients get progressively older.
ACC / AHA Guidelines- Evaluation of the Unoperated Patient (DO NOT EDIT)[1]
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Class I1. Atrial septal defect (ASD) should be diagnosed by imaging techniques with demonstration of shunting across the defect and evidence of right ventricular (RV) volume overload and any associated anomalies. (Level of Evidence: C) 2. Patients with unexplained RV volume overload should be referred to an adult congenital heart disease (ACHD) center for further diagnostic studies to rule out obscure ASD, partial anomalous venous connection, or coronary sinoseptal defect.(Level of Evidence: C) |
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References
- ↑ Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (23): e1–121. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.