Atrial septal defect physical examination: Difference between revisions
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'''In individuals with an ASD, there is a | '''In individuals with an ASD, there is a fixed splitting of S<sub>2</sub>. The reason why there is a fixed splitting of the second heart sound is that the extra blood return during inspiration gets equalized between the left and right atrium due to the communication that exists between the atria in individuals with ASD''' | ||
Revision as of 02:43, 18 August 2011
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, MBBS [[2]]; Cafer Zorkun, M.D., Ph.D. [3]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [[4]]
Overview
Upon physical examination, a patient with an atrial septal defect may present with an ejection systolic murmur caused by the fixed splitting of S2.
Physical examination
The physical findings in an adult with an ASD include those related directly to:
- The intracardiac shunt
- Right heart failure
Systolic Ejection Murmur
Upon auscultation of the heart sounds, there may be an ejection systolic murmur that is attributed to the pulmonic valve. This is due to the increased flow of blood through the pulmonic valve rather than any structural abnormality of the valve leaflets.
Fixed Splitting of S2
<youtube v=5tBk1XuEyuM/>
In individuals with an ASD, there is a fixed splitting of S2. The reason why there is a fixed splitting of the second heart sound is that the extra blood return during inspiration gets equalized between the left and right atrium due to the communication that exists between the atria in individuals with ASD
In unaffected individuals, there are respiratory variations in the splitting of the second heart sound (S2). During respiratory inspiration, the negative intrathoracic pressure causes increased blood return into the right side of the heart. The increased blood volume in the right ventricle causes the pulmonic valve to stay open longer during ventricular systole. This causes a normal delay in the P2 component of S2. During expiration, the positive intrathoracic pressure causes decreased blood return to the right side of the heart. The reduced volume in the right ventricle allows the pulmonic valve to close earlier at the end of ventricular systole, causing P2 to occur earlier.