In this episode, we review atrial septal defects (ASDs), one of the most common congenital heart defects characterized by persistent communication between the atria resulting in a left-to-right shunt. We discuss the major ASD subtypes, including secundum, primum, sinus venosus defects, and patent foramen ovale, along with the pathophysiology behind right heart enlargement and pulmonary overcirculation. Clinical presentation ranges from asymptomatic childhood disease to adult symptoms such as fatigue, dyspnea, palpitations, syncope, and exercise intolerance. Key physical exam findings including fixed splitting of S2 and systolic flow murmurs are highlighted, as well as classic diagnostic findings on echocardiography and EKG. We also cover indications for surgical versus transcatheter closure, long-term complications such as pulmonary hypertension and atrial arrhythmias, and important clinical pearls for recognizing and managing ASD in both pediatric and adult patients.

References

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