Diseases
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Pathophysiology
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Shunt
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Symptoms
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Diagnosis
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Echocardiography findings
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Physical examination
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Treatment
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Complications
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Patent foramen ovale
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- Failure of fusion of the septum primum and septum secundum leading to a flap valve opening.
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- More prominent with increased right atrial pressure.
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- Majority of patients are asymptomatic
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- Appearance of at least 3 micro-bubbles in the left atrium within three cardiac cycles after the complete opacification of the right atrium
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- Percutaneous closure
- Anticoagulants
- Antiplatelets
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- Migraine with aura
- Decompression sickness in divers
- Platypnea-orthodeoxia syndrome
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Atrial septal defect
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- Ostium secundum defect: Failure of the septum secundum to occlude the ostium secundum.
- Ostium primum defect: Failure of the ostium primum to fuse with the endocardial cushions.
- Superior sinus venosus defect: The orifice of the superior vena cava overrides the atrial septum above the fossa ovalis.
- Inferior sinus venosus defect: The orifice of the inferior vena cava overrides the left and right atrium.
- Coronary sinus defect: Absence of a portion of the common wall that separates the coronary sinus and the left atrium.
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- Continuous left-to-right shunt
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- Failure to thrive, tachypnea, recurrent respiratory infections, heart failure
- Commonly asymptomatic during childhood and adolescence
- Adults with large shunts may become symptomatic in the fourth decade presenting with fatigue, exercise intolerance, palpitations, syncope, and shortness of breath.
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- TTE (Gold standard)
- Cardiac CT
- Cardiac MRI
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- Hypermobile interatrial septum
- Abrupt septal irregularity
- Right atrial and ventricular volume overload
- Pulmonary artery dilation
- Coronary sinus defect: Enlarged ostium of the coronary sinus and unroofing of the terminal portion of the coronary sinus
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- Systolic flow murmur in the pulmonary valve region
- Wide, fixed splitting of S2
- Diastolic flow rumble across the tricuspid valve
- Right ventricular heave
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- Spontaneous closure
- Percutaneous transcatheter closure
- Surgical closure
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- Right sided heart failure
- Peripheral edema
- Eisenmenger syndrome (cyanosis)
- Paradoxical emboli
- Pulmonary hypertension
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Pulmonary ateriovenous fistula
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- Abnormal blood vessel(s) connecting the pulmonary arteries and veins directly without interposition of pulmonary capillaries
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- Right-to-left shunt between the pulmonary artery and pulmonary vein
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- Symptoms may occur only after the second decade
- Cyanosis
- Hemoptysis
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- Chest CT
- Pulmonary arteriogram
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- Appearance of contrast bubbles in the left atrium three to five cardiac cycles after appearance in the right atrium
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- Clubbing
- Systolic/continuous murmur
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- Embolization
- Surgical resection
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- Cerebral ischemia/abscess
- Hemothorax
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