A site for medical students - Practical,Theory,Osce Notes

How will you clinically diagnose atrial septal defect?

Atrial septal defect is the most common congenital heart disease in adult.
It can be diagnosed based on clinical symptoms and signs.
The most common symptoms of ASD are
  • Dyspnoea on exertion
  • Palpitation
  • Recurrent chest infection 
Examination will show the following features
Pulse, blood pressure and jugular venous pressure are normal
Precordial bulge may be seen
Apex beat is normal.
P2 is palpable and pulmonary artery pulsation may be felt
Systolic thrill may be present in 2nd left inter costal space
Left parasternal heave present 
On auscultation 
S1 is loud
P2 is loud
Wide fixed split of S2 is present
There may be an ejection systolic murmur (ESM)which is heard at the pulmonary area 
The striking features are
  • Palpable P2
  • Left parasternal heave
  • Systolic thrill in 2nd left intercostals space
  • Wide fixed split S2
  • ESM in pulmonary area
What are the causes of thrill in ASD?