Atrial septal defect electrocardiogram: Difference between revisions
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==Electrocardiography== | ==Electrocardiography== | ||
The [[ECG]] findings in [[atrial septal defect]] vary with the type of defect present. It may be normal with an uncomplicated ASD and a small shunt. Individuals with [[atrial septal defect]]s may have a prolonged [[PR interval]] (a [[first degree heart block]]). The prolongation of the [[PR interval]] is probably due to the enlargement of the atria that is common in [[ASD]]s and the increased distance due to the defect itself. | |||
The [[ECG]] findings in [[atrial septal defect]] vary with the type of defect present. | |||
# It may be normal with an uncomplicated ASD and a small shunt. | |||
# Individuals with [[atrial septal defect]]s may have a prolonged [[PR interval]] (a [[first degree heart block]]). The prolongation of the [[PR interval]] is probably due to the enlargement of the atria that is common in [[ASD]]s and the increased distance due to the defect itself. The first degree heart block is found to happen more frequently with ostium primum ASD compared to the other types due to the involvement of 'Bundle of His' present in the close proximity of the defect. Both of these can cause an increased distance of internodal conduction from the [[SA node]] to the [[AV node]].<!-- | |||
--><ref>{{cite journal | author = Clark E, Kugler J | title = Preoperative secundum atrial septal defect with coexisting sinus node and atrioventricular node dysfunction. | journal = Circulation | volume = 65 | issue = 5 | pages = 976-80 | year = 1982 | id = PMID 7074763}}</ref> | --><ref>{{cite journal | author = Clark E, Kugler J | title = Preoperative secundum atrial septal defect with coexisting sinus node and atrioventricular node dysfunction. | journal = Circulation | volume = 65 | issue = 5 | pages = 976-80 | year = 1982 | id = PMID 7074763}}</ref> | ||
# Incomplete and less frequently complete [[Right Bundle Branch Block]] ([[RBBB]]) is often present. | # Incomplete and less frequently complete [[Right Bundle Branch Block]] ([[RBBB]]) is often present. | ||
# [[Right Ventricular Hypertrophy]] ([[RVH]]) with strain suggests onset of [[pulmonary hypertension]] or associated [[pulmonic stenosis]]. | # [[Right Ventricular Hypertrophy]] ([[RVH]]) with strain suggests onset of [[pulmonary hypertension]] or associated [[pulmonic stenosis]]. | ||
# The QRS complex may be slightly prolonged and has a characteristic rSr' or rsR' pattern that is contributed to the disproportionate thickening of the right ventricular outflow tract (the last portion of the ventricle to depolarize). | # The QRS complex may be slightly prolonged and has a characteristic rSr' or rsR' pattern that is contributed to the disproportionate thickening of the right ventricular outflow tract (the last portion of the ventricle to depolarize). | ||
# 2 out of 3 patients with an [[ostium secundum ASD]] have [[right axis deviation]]. | # 2 out of 3 patients with an [[ostium secundum ASD]] have [[right axis deviation]]. | ||
# Patients with [[ostium secundum ASD]]s often develop [[atrial fibrillation]] or [[atrial flutter]], and this occurs with a higher incidence with increasing age and with [[pulmonary hypertension]]. | # Patients with [[ostium secundum ASD]]s often develop [[atrial fibrillation]] or [[atrial flutter]], and this occurs with a higher incidence with increasing age and with [[pulmonary hypertension]]. | ||
# [[Ostium primum ASD]]s are associated with a marked left axis deviation. | # [[Ostium primum ASD]]s are associated with a marked left axis deviation. | ||
# Individuals with a [[sinus venosus ASD]] exhibit a left axis deviation of the [[P wave]] (not the [[QRS]] complex). | # Individuals with a [[sinus venosus ASD]] exhibit a left axis deviation of the [[P wave]] (not the [[QRS]] complex). | ||
# [[Sinus venosus ASD]]s are often associated with low atrial and [[junctional rhythm|junctional rhythms]]. | |||
[[Image:ASDPrimum.jpg|300px|left|thumb|12 lead EKG shows the rSR' pattern in V1 (R' greater than S with T wave inversion which is commonly seen in volume overload in Right Ventricular Hypertrophy)]] | [[Image:ASDPrimum.jpg|300px|left|thumb|12 lead EKG shows the rSR' pattern in V1 (R' greater than S with T wave inversion which is commonly seen in volume overload in Right Ventricular Hypertrophy)]] | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [[2]]; Cafer Zorkun, M.D., Ph.D. [3]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [[4]]
Overview
Electrocardiogram may be used as a diagnostic tool in the evaluation of an atrial septal defect. ECG findings associated with an atrial septal defect include right bundle branch block, right ventricular hypertrophy, left and right axis deviation, atrial fibrillation, atrial flutter, and junctional rhythms.
Electrocardiography
The ECG findings in atrial septal defect vary with the type of defect present.
- It may be normal with an uncomplicated ASD and a small shunt.
- Individuals with atrial septal defects may have a prolonged PR interval (a first degree heart block). The prolongation of the PR interval is probably due to the enlargement of the atria that is common in ASDs and the increased distance due to the defect itself. The first degree heart block is found to happen more frequently with ostium primum ASD compared to the other types due to the involvement of 'Bundle of His' present in the close proximity of the defect. Both of these can cause an increased distance of internodal conduction from the SA node to the AV node.[1]
- Incomplete and less frequently complete Right Bundle Branch Block (RBBB) is often present.
- Right Ventricular Hypertrophy (RVH) with strain suggests onset of pulmonary hypertension or associated pulmonic stenosis.
- The QRS complex may be slightly prolonged and has a characteristic rSr' or rsR' pattern that is contributed to the disproportionate thickening of the right ventricular outflow tract (the last portion of the ventricle to depolarize).
- 2 out of 3 patients with an ostium secundum ASD have right axis deviation.
- Patients with ostium secundum ASDs often develop atrial fibrillation or atrial flutter, and this occurs with a higher incidence with increasing age and with pulmonary hypertension.
- Ostium primum ASDs are associated with a marked left axis deviation.
- Individuals with a sinus venosus ASD exhibit a left axis deviation of the P wave (not the QRS complex).
- Sinus venosus ASDs are often associated with low atrial and junctional rhythms.
References
- ↑ Clark E, Kugler J (1982). "Preoperative secundum atrial septal defect with coexisting sinus node and atrioventricular node dysfunction". Circulation. 65 (5): 976–80. PMID 7074763.