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Case History :

A 5 year old boy was brought to the pediatric unit of our hospital with complaints of fatigue, shortness of breath and recurrent upper respiratory tract infections. The parents of the boy state that the boy is dull and often disinterested in his surroundings. The boy does not make any friends and would not play any games that involve physical activity.

In the present instance the boy developed Shortness Of Breath during the physical exercise classes in his school and complained of dizziness associated with near syncope. He was directly admitted to the hospital by the school authorities and his parents were summoned to the hospital.

The pediatrician on duty has taken the relevant history of the patient. Past history revealed recurrent pyrexial episodes and delayed developmental milestones. There was no other pertinent history. The patient was immediately referred to the cardiology unit by the attending pediatrician on suspicion of cardiac disease.

Clinical Examination

The Patient was alert and responsive, the pulse rate was 102 /min and regular, BP was 110/80.Cardiac exam showed a mild ejection systolic murmur at the left sternal border grade II.

Investigations

An EKG and Chest X-ray were taken and revealed the following

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Investigation Reports :

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Discussion :

Untreated ASDs are known to cause problems in adulthood. These problems may include pulmonary hypertension, congestive heart failure, atrial arrhythmias and an increased risk of stroke.

In most children, Atrial Septal Defects cause no symptoms. A very large defect may allow enough blood flow through it to cause Congestive Heart Failure symptoms such as shortness of breath, easy fatigability, or poor growth. Presentation with a heart murmur, during physical examination is the most common mode of initial diagnosis of this condition. Apart from the murmur the second heart sound is characteristically "split"

Echocardiography is the primary method used to confirm the presence of an Atrial Septal Defect. It can show not only the hole and its size, but also any hypertrophy of the right atrium and ventricle in response to the increased workload.

Chest X-ray may show cardiomegaly and increased pulmonary blood flow.

Open-heart surgery remains the most common mode of closure of ASDs.However, depending on size and the area of the septum involved, some Atrial Septal Defects may be closed by device placement during through cardiac catheterization.

Following closure of an ASD, there should be no problems with physical activity and no restrictions. The patient should however be regularly followed up.

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