Atrial septal defect electrocardiogram: Difference between revisions

Jump to navigation Jump to search
m (Bot: Adding CME Category::Cardiology)
 
(31 intermediate revisions by 7 users not shown)
Line 1: Line 1:
__NOTOC__
{{Atrial septal defect}}
{{Atrial septal defect}}
{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [[mailto:psingh@perfuse.org]]; {{CZ}}; '''Assistant Editor(s)-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [[mailto:kfeeney@perfuse.org]]
{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com]; {{CZ}} '''Assistant Editor(s)-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@elon.edu]
 
==Overview==
==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]] may include [[right atrial enlargement]], [[right-axis deviation]], PR prolongation ([[first degree heart block]]), [[right bundle branch block]], [[right ventricular hypertrophy]], left and [[right axis deviation]], [[atrial fibrillation]], [[atrial flutter]], and [[junctional rhythm|junctional rhythms]].
Electrocardiogram may be used as a diagnostic tool in the evaluation of an atrial septal defect. [[ECG]] findings associated with an atrial septal defect may include [[right atrial enlargement]], [[right axis deviation]], [[PR prolongation]] ([[first degree heart block]]), [[right bundle branch block]], [[right ventricular hypertrophy]], left and [[right axis deviation]], [[atrial fibrillation]], [[atrial flutter]], and [[junctional rhythm|junctional rhythms]].


==Electrocardiography==
==Electrocardiogram==
 
The [[ECG]] findings in atrial septal defect vary with the type of defect present.  
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.  
* 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]].<!--
* 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.  
  --><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.
 
* [[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]], incomplete right bundle-branch block.
* 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).
===Lesion Specific Electrocardiogram Findings===
* [[Ostium secundum ASD]]- 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]]. 2 out of 3 patients with an ostium secundum ASD have [[right axis deviation]], incomplete [[right bundle-branch block]].


* 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]] - 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> Ostium primum ASDs are associated with a marked superior left axis deviation.


* [[Ostium primum ASD]]s are associated with a marked superior left axis deviation.
* [[Sinus venosus ASD]] - Individuals with a sinus venosus ASD exhibit a left axis deviation of the [[P wave]] (not the [[QRS]] complex). It is often associated with low atrial and [[junctional rhythm|junctional rhythms]], abnormal P-wave axis.  


* Individuals with a [[sinus venosus ASD]] exhibit a left axis deviation of the [[P wave]] (not the [[QRS]] complex).
* Familial ASD - [[Complete heart block]] may be present in association with familial ASD <ref name="pmid5437412">{{cite journal| author=Bizarro RO, Callahan JA, Feldt RH, Kurland LT, Gordon H, Brandenburg RO| title=Familial atrial septal defect with prolonged atrioventricular conduction. A syndrome showing the autosomal dominant pattern of inheritance. | journal=Circulation | year= 1970 | volume= 41 | issue= 4 | pages= 677-83 | pmid=5437412 | doi= | pmc= | url= }} </ref>.  


* [[Sinus venosus ASD]]s are often associated with low atrial and [[junctional rhythm|junctional rhythms]], abnormal P-wave axis.
----
The 12 lead EKG below 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]])


* Complete heart block may be present in association with familial ASD.
[[Image:ASDPrimum.jpg|500px|center|]]
----
The 12 lead EKG below shows [[right atrial enlargement]] and an 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)]]
[[Image:Asd ecg.jpg|center|500px]]
<br clear="left"/>


==References==
==References==
{{reflist}}
{{reflist|2}}
{{WH}}
{{WS}}
[[CME Category::Cardiology]]


[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Congenital heart disease]]
[[Category:Congenital heart disease]]
[[Category:Mature chapter]]
[[Category:Pediatrics]]
 
[[Category:Embryology]]
{{WH}}
[[Category:Disease]]
{{WS}}
[[Category:Best pages]]

Latest revision as of 01:52, 15 March 2016

Atrial Septal Defect Microchapters

Home

Patient Information

Overview

Anatomy

Classification

Ostium Secundum Atrial Septal Defect
Ostium Primum Atrial Septal Defect
Sinus Venosus Atrial Septal Defect
Coronary Sinus
Patent Foramen Ovale
Common or Single Atrium

Pathophysiology

Epidemiology and Demographics

Risk Factors

Natural History and Prognosis

Complications

Diagnosis

History and Symptoms

Physical Examination

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography

Transesophageal Echocardiography
Transthoracic Echocardiography
Contrast Echocardiography
M-Mode
Doppler

Transcranial Doppler Ultrasound

Cardiac Catheterization

Exercise Testing

ACC/AHA Guidelines for Evaluation of Unoperated Patients

Treatment

Medical Therapy

Surgery

Indications for Surgical Repair
Surgical Closure
Minimally Invasive Repair


Robotic ASD Repair
Percutaneous Closure
Post-Surgical Follow Up

Special Scenarios

Pregnancy
Diving and Decompression Sickness
Paradoxical Emboli
Pulmonary Hypertension
Eisenmenger's Syndrome
Atmospheric Pressure

Case Studies

Case #1

Atrial septal defect electrocardiogram On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Atrial septal defect electrocardiogram

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Atrial septal defect electrocardiogram

CDC on Atrial septal defect electrocardiogram

Atrial septal defect electrocardiogram in the news

Blogs on Atrial septal defect electrocardiogram

Directions to Hospitals Treating Type page name here

Risk calculators and risk factors for Atrial septal defect electrocardiogram

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 may include right atrial enlargement, right axis deviation, PR prolongation (first degree heart block), right bundle branch block, right ventricular hypertrophy, left and right axis deviation, atrial fibrillation, atrial flutter, and junctional rhythms.

Electrocardiogram

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.

Lesion Specific Electrocardiogram Findings

  • Ostium primum ASD - 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] Ostium primum ASDs are associated with a marked superior left axis deviation.

The 12 lead EKG below 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)


The 12 lead EKG below shows right atrial enlargement and an rSR' pattern in V1 (R' greater than S with T wave inversion which is commonly seen in volume overload in right ventricular hypertrophy)

References

  1. 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.
  2. Bizarro RO, Callahan JA, Feldt RH, Kurland LT, Gordon H, Brandenburg RO (1970). "Familial atrial septal defect with prolonged atrioventricular conduction. A syndrome showing the autosomal dominant pattern of inheritance". Circulation. 41 (4): 677–83. PMID 5437412.

Template:WH Template:WS CME Category::Cardiology