Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for evaluation of a known or suspected ostium primum atrial septal defect. History significant for [exertional dyspnea / fatigue / recurrent respiratory infections / palpitations]. No history of cyanosis or syncopal episodes. Growth parameters noted as [normal / failure to thrive]. Family history negative for congenital heart disease.
Clinical Examination Findings
Cardiovascular exam reveals a hyperdynamic precordium with a palpable right ventricular heave. Auscultation demonstrates a fixed, widely split S2. A grade [I-VI/VI] systolic ejection murmur is noted at the left upper sternal border (pulmonary flow murmur). A holosystolic murmur at the apex may be present, suggestive of associated mitral valve regurgitation (cleft mitral valve). Peripheral pulses are symmetric; no peripheral edema noted.
Treatment Protocol
Plan: 1. Echocardiogram (TTE/TEE) to confirm defect size, location, and assess mitral valve morphology. 2. ECG to evaluate for left axis deviation and first-degree AV block. 3. Referral to Pediatric Cardiology/Cardiothoracic Surgery for surgical closure assessment. 4. Prophylaxis for infective endocarditis if indicated. 5. Monitor for signs of pulmonary hypertension or heart failure.