Classifications (affect Tm)

• Sinus venosus defect → associated with pulmonary vein abnormalities
• Primum ASD → associated with AV valve abnormalities, AVSD (down syndrome, endocardial cushion defect)
• Secondum ASD → isolated

Relevant Physiology

Pathogenesis

• L → R shunt → RV volume overload → Increased pulmonary blood flow (PBF) + RV dilation

Complication

• !AFib - Atrial Fibrillation - due to RA dilation
• PH - Pulmonary hypertension - due to increased pulmonary outflow
• Paradoxical embolism Arterial Embolism ALIs (4)
  • If RV pressure got so high that a R → L shunt happens
• Eisenmenger Syndrome over time

Presentation

Signs and Symptoms

• Young: asymptomatic
• Older: dyspnea upon exercise
• Precordial bulge - RV hypertrophy

Precordial exam: Murmur, Heart Sound

• Heart Sound: Fixed, Wide S2
  • delayed closure of pulmonic valve due to PH - Pulmonary hypertension