Small Hearts, Big Saves:
Ultrasound Education of the Week
By: Maria Tama, MD
Case:
16 year old F presents with sudden onset sharp chest pain. No trauma. No recent illnesses. No fever or uri symptoms. No family history of any cardiac concerns. Reports she has not seen her primary doctor but goes to her school clinic for vaccines. No cough or vomiting. Has no other complaints.
Vitals T 98.4 F HR 92bpm BP 111/71 RR 18 O2 97%RA
PE well appearing comfortable no tachypnea no distress
HEENT WNL
CVS s1 s2 possible murmur no extra heart sounds
Lungs cta bilaterally
Abd soft ndnt no hepatosplenomegaly
EXT from x 4 no LE edema
Skin no rashes wwp good cap refill
You obtain an EKG and do a bedside ultrasound:
Is this a normal echo??
After putting your ekg and echo finding together, you are concerned for right heart enlargement.
Does she have a PE?? Something else??
Atrial Septal Defects (ASD)
Atrial septal defects (ASDs) are congenital heart anomalies characterized by an abnormal opening in the atrial septum, allowing blood to flow between the left and right atria. This left-to-right shunting of blood can lead to increased pulmonary blood flow and right-sided heart volume overload. ASDs are among the most common congenital heart defects, accounting for approximately 6-10% of all congenital heart defects in children.
Large ASDs can cause symptoms such as fatigue, failure to thrive, frequent respiratory infections, exercise intolerance, and signs of heart failure in severe cases
EKG: rsR' in v1 ( right conduction delay) is a classic finding in ASD.
POCUS: Look for a lack of septum between the atria, most notably can be seen in subxiphoid view. Use color flow to look for back and forth motion of the blood between the two chambers.
Tama's Tips
Right heart dilation and left-to-right shunts:
ASDs are a common cause of isolated right heart dilation. Left-to-right shunts typically result in volume overload, but only ASDs lead to right-sided heart dilation. In contrast, VSDs and PDAs cause left-sided heart dilation.
Timely repair is essential:
Large ASDs (and other forms of hemodynamically significant left-to-right shunts) must be repaired to prevent the development of irreversible pulmonary hypertension,right heart failure, atrial arrythmias, eisenmengr syndrome. which can occur over time. Urgent cardiology referral is necessary.