Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for evaluation of suspected secundum ASD. Reports history of exertional dyspnea, reduced exercise tolerance, and occasional palpitations. Denies syncope, chest pain, or orthopnea. No prior history of paradoxical emboli or cryptogenic stroke.
Clinical Examination Findings
Cardiovascular exam reveals a hyperdynamic precordium with a palpable right ventricular heave. Auscultation demonstrates a fixed, widely split second heart sound (S2) at the left upper sternal border, accompanied by a grade II/VI systolic ejection murmur at the pulmonic area due to increased flow across the pulmonary valve. No signs of peripheral edema or jugular venous distension.
Treatment Protocol
Management plan includes echocardiographic assessment of shunt fraction (Qp/Qs) and right heart dimensions. If hemodynamically significant (Qp/Qs > 1.5:1), elective transcatheter closure using an ASD occluder device is indicated. Post-procedure care involves antiplatelet therapy (aspirin) for 6 months and antibiotic prophylaxis for infective endocarditis for the first 6 months post-closure.