How would you investigate a patient with atrial septal defect ?
ECG
• Often has right axis deviation and incomplete right bundle branch block.
• In ostium primum defects left axis deviation also occurs, whereas a junctional or low atrial rhythm (inverted P waves in inferior leads) occurs in sinus venosus defects.
Chest radiography
• Prominent pulmonary arteries (large pulmonary conus).
• A peripheral pulmonary vascular pattern of 'shunt vascularity' (in which the small pulmonary arteries are especially well visualized in the periphery of both lungs).
• Small aortic knob. • Enlarged right ventricle and right atrium.
• 'Hilar dance' on fluoroscopy.
Echocardiography
• Transthoracic echocardiography visualizes ostium secundum and primum defects but usually does not identify sinus venosus defects. • Sensitivity can be enhanced by injecting microbubbles into a peripheral vein. after which the movement across the defect can be seen.
• Trans-oesophageal and Doppler colour-flow echocardiography is useful in detecting and determining the location of atrial septal defects and also in identifying anomalous venous drainage and sinus venosus defects.
Cardiac catheterization Often unnecessary in diagnosis but is useful in determining the magnitude and direction of shunting and to determine the severity and reversibility of pulmonary hypertension.
Lexo edhe:
ECG
• Often has right axis deviation and incomplete right bundle branch block.
• In ostium primum defects left axis deviation also occurs, whereas a junctional or low atrial rhythm (inverted P waves in inferior leads) occurs in sinus venosus defects.
Chest radiography
• Prominent pulmonary arteries (large pulmonary conus).
• A peripheral pulmonary vascular pattern of 'shunt vascularity' (in which the small pulmonary arteries are especially well visualized in the periphery of both lungs).
• Small aortic knob. • Enlarged right ventricle and right atrium.
• 'Hilar dance' on fluoroscopy.
Echocardiography
• Transthoracic echocardiography visualizes ostium secundum and primum defects but usually does not identify sinus venosus defects. • Sensitivity can be enhanced by injecting microbubbles into a peripheral vein. after which the movement across the defect can be seen.
• Trans-oesophageal and Doppler colour-flow echocardiography is useful in detecting and determining the location of atrial septal defects and also in identifying anomalous venous drainage and sinus venosus defects.
Cardiac catheterization Often unnecessary in diagnosis but is useful in determining the magnitude and direction of shunting and to determine the severity and reversibility of pulmonary hypertension.
loading...
Lexo edhe:
