Case Report

ATRIAL SEPTAL
DEFECT
Presented by:
ANDI DEWI PRATIWI
C111 11 153

Supervisor:
dr. Akhtar Fajar M, Sp.JP, FIHA
Cardiology and Vascular Medicine Department
Medical Faculty of Hasanuddin University
Makassar
2015

PATIENTS IDENTITY

Name
: Ms. J
Age
: 22 years old
Sex
: Female
Admission date : August 8th, 2015
Medical record : 699600

HISTORY TAKING
Chief complaint: shortness of breath
Suffered since 3 months before admission
Orthopneu (-), dyspneu on effort (+), paroxysmal
nocturnal dyspneu (-)
Palpitation (+)
Chest pain (+), intermittently, not radiating down
the arm
Fatigue (+)
Fever (-) cough (-) headache (-) epigastric pain (-)
nausea & vomiting (-)
Urination & defecation normal

HISTORY TAKING

History of outpatient in Wahidin

Sudirohusodo Hospital 3 months ago
because of goiter
History of previous shortness of breath (-)
History of chest pain (-)
History of hypertension (-)
History of diabetes mellitus (-)
History of smoking (-)
History of heart disease in family (-)

RISK FACTOR

Modifiable
-

Non
modifiable
Gender :
female
History of alcohol,
drugs, or illness of
mother during
pregnancy (-)
history of
family with
same
disease (-)

Histrry of family
with other
kongenital disease
(-)

PHYSICAL
EXAMINATION

Gener
al
state

Moderate illness
Under-nourished
Compos mentis

Vital
signs

BP: 110/80 mmHg

HR: 78/i
RR: 22x/i
Temp: 36,5oC

Head
& neck

Anemic (-) icterus (-) cyanotic

(-)
DVS R+2 cmH2o
Thyroid enlargement , grade IB

PHYSICAL
EXAMINATION
THORAX
I: symmetric,
normochest
P: tumor mass (-)
tenderness (-)
P: sonor, pulmohepar border : 6th
ICS ant. dextra
A: vesicular, ronkhi
(-) wheezing (-)

COR
I : apex cordis not
seen
P: apex cordis not
palpable
P : dull, left border :
ICS V linea
midclavicularis
sinistra
A : S1/S2 regular,
systolic ejection
murmur in ICS II

PHYSICAL
EXAMINATION
ABDOMEN
I: convex,
symmetric,
following breath
movement
A: peristaltic (+),
normal
P: tenderness (-),
tumor mass (-),
hepar and spleen
not palpable
P: tympani(+),
ascites(-)

EXTREMITIES
Edema -/-

ELECTROCRADIOGRAPH
Y (15/8/2015)

INTERPRETATION
Rhytm
: Sinus
Heart rate
: 94x/i
Regularity
: regular
Axis
: Right Axis
Deviation
P wave
: 0,08 sec
PR interval
: 0,20 sec
QRS complex
: RsR
morphology in lead V1, III, V3,
AVL, R wave is taller
than S
wave in lead V1
ST segment
: normal
T wave
: normal

CONCLUSION:
Sinus rhytm, HR 94 x/min, righ
axis deviation with incomplete
RBBB, right ventricle

CHEST X-RAY (6/8/2015)

- Lung bronchovascular
marking increased.
- Cor difficult to assess,
the impression enlarged.
Heart waist prominent,
elevated apex (RVE),
normal aorta
- Both sinus and
diaphragm well
- The bones intact
Conclusion :
Cardiomegaly with
signs L to R shunt

LABORATORY RESULT
(1/8/2015)
Lab

Value

Unit

WBC

5,1

(10/UI)

RBC

4,71

(106/UI)

HGB

12,1

(gr/dL)

HCT

36,2

PLT

212

PT

Lab

Value

Unit

GDS

85

mg/dL

Ureum

19

mg/dL

Creatinin

0,5

mg/dL

(103/uL)

SGOT

18

u/L

11,9

Second

SGPT

19

u/L

APTT

28,4

Second

Natrium

142

mmol/L

INR

1,11

Kalium

3,9

mmol/L

FT4

2,71

ng/dl

TSHS

<0,05

mlU/ml

Klorida

111

mmol/L

TRANSTHORACIC
ECHOCARDIOGRAM
(21/5/2015)
CONCLUSION
ASD secundum
enlarged with
left to the right
shunt
Moderate
Pulmonary
hypertension
Dilatation the
right atrium
and right

TRANSESOPHAGEAL
ECHOCARDIOGRAPHY
(21/5/2015)

CONCLUSION
secundum ASD

DIAGNOSIS

SECUNDUM ATRIAL SEPTAL DEFECT WITH

MODERATE PULMONARY HYPERTENSION

TREATMENT

SYMPTOMATIC TREATMENT (DIURETIC,

BERAPROST SODIUM)
ATRIAL SEPTAL DEFECT CLOSURE WITH
AMPLATZER SEPTAL OCCLUDER

ATRIAL SEPTAL
DEFECT

DEFINITION

Atrial septal defect (ASD) is a

congenital heart defect in which
persistent
opening in the interatrial septum
allows direct communication between

EPIDEMIOLOGY

Incidence : ASD occur on 1 by 1500 live

birth.

ASD occurs with a female-to-male ratio

of approximately 2:1
Secundum ASD account for
75% of all ASDsand 30% to 40% of
congenital disease seen in patients older
than 40 years

CLASSIFICATION
Secundu
m ASD

Type
ASD
Primum
ASD

Sinus
Venosus
ASD

Etiolog
y
Risk
Factor

mutation in gen
cardiac
transcription
factor NKX2.5
Prenatal factor
Genetic factor

PATOPHYSIOLOGY

CLINICAL
MANIFESTATION
palpitation

dyspnea on exertion

fatigue

Chest pain
recurrent lower respiratory tract
infections

Pathomechanism of
Symptoms
Dyspnea
Long
Standing L
to R shunt

Inhibition
of diffusion
O2 on lung

Hypervascul
arization of
pulmonary
circulation

Transudation
of fluid from
capillary to
interstitial

Vascular
bed filled
with blood

Pulmonary
hypertension
and
Hydrostatic
pressure
elevated

Dyspnea

Pathomechanism of
Symptoms

Fatigue
L to R
shunt

Perfusio
n
decreas
e

Ischemic
and
metaboli
sm
disorder

Volume
systolic
of LV
decreas
e

Blood
containi
ng
oxygen
decreas
e

Fatigu
e

Pathomechanism of
Symptoms

Angina

Systemic
circulation
decrease

Coronary
circulation
decrease

Right volume
overload

Pulmonary
hypertension

Wall-Stress
increases of RV

Oxygen demand
increase-Oxygen
supply decrease

Angina

Pathomechanism of
Symptoms
Palpitation
Left to Right
Shunt

Dilatation of
right atrium
and right
ventricle

Prolonged of
conduction
pathway

Palpitatio
n

Atrial
Fibrillation/
SVT/ PAT

re-entry
current

Pathomechanism of
Symptoms
Recurrent of respiratory
tract infection

DIAGNOSIS

EXAMINATION

COMPLICATION

TREATMENT

DEFINITIVE TREATMENT

INTERVENTIONAL

AMPLATZER SEPTAL
OCCLUDER

REFERENCES

1. Manurung D. Defek Septum Atrial. In: Sudoyo A,

Setiyohadi B, Alwi I, Simadibrata M, Setiati S, editors.
Buku Ajar Ilmu Penyakit Dalam. V ed. Jakarta: Interna
Publishing; 2009. p.
2. Braunwald, Eugene et al. Braunwald's Heart Disease
A Textbook Of Cardiovascular Medicine. Elsevier. 2015.
3. Lilly Leonard S. Pathophysiology of Heart Disease.
Wolters Kluwer. 5th edition. 2011.
4. Rilantono, Lily Ismudiati. Buku Ajar Kardiologi.
Jakarta : Fakultas Kedokteran Universitas Indonesia.
2004.
5. Topol Eric J. Textbook of Cardiovascular Medicine.
Lippincott Williams & Wilkins. 2nd Edition. 2002.

THANK YOU

SIRKULASI DARAH
JANIN

Patent Foramen Ovale

VS ASD