A 45 year-old lady has 10 months history of shortness of breath. She is found to have
irregularly irregular pulse and loud P2 with fixed splitting and ejection systolic murmur in left
2nd ICS. What is the probable diagnosis?
- a. TOF
- b. ASD
- c. VSD
- d. PDA
- e. CoA
0 voters
Ans. The key is B. Atrial septal defect. [Most adult patients with a large defect present with (some or all)
symptoms including fatigue, exercise intolerance, palpitations, syncope, shortness of breath, peripheral
oedema, thromboembolic manifestations, and cyanosis. Arrhythmias are more common after 40 years
of age. The common arrhythmias are atrial flutter and atrial fibrillation. Auscultatory findings are:
• Loud P2 with fixed splitting of 2nd heart sound. A left-to-right shunt caused increased loading on
the right ventricle, leading to delayed emptying and therefore delayed closure of the pulmonary
valve which caused this splitting.
• Soft systolic ejection murmur in the pulmonary area at the upper left sternal border.
• A diastolic rumble over the left lower sternum because of increased flow through the tricuspid
valve.
Classic auscultatory findings as described above are not present unless the shunt is reasonably large.