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Atrial Septal Defect


Step 1: View clinicals

A 20 year old girl presents with exertional dyspnea and palpitations for 5 months. There is no history of a cough, chest pain, orthopnea or paroxysmal nocturnal dyspnea. Her medical and family histories are unremarkable.

Step 2: Order all relevant investigations


The ECG reveals P-pulmonale, right axis deviation, and a right bundle branch block.

Chest X-Ray

There is mild enlargement of the right side of the cardiac silhouette.


An osteum secondum atrial septal defect 1 cm in diameter is noted, with a left to right shunt. The ratio of pulmonary to systemic flow is approximately 1:1.6. The right atrium and ventricle are moderately dilated.

Coronary Angiogram

Coronary Angiography demonstrates a normal coronary vasculature.

Step 3: Select appropriate management

Endocarditis Prophylaxis
Antiarrythmic therapy
Device closure
Heart-lung Transplantation

Score: ★★☆