20-4
Chapter One
Secundum atrial septal defect
Sabrina D. Phillips
A 20-year-old woman presented for evaluation of palpitations and one episode of near
syncope after exertion. Her past medical history was remarkable only for a diagnosis
of exercise-induced asthma. She was involved in competitive sports at her University,
participating on the track team. She denied any chest discomfort, dyspnea at rest, or
perceived exercise limitation. She had never had lower extremity edema, orthopnea, or
paroxysmal nocturnal dyspnea. There was no history of cardiac or pulmonary disease
in her family. Physical exam revealed a normal jugular venous pressure. The carotid
upstroke was normal. The lungs were clear to auscultation and percussion bilaterally.
The cardiac exam was notable for a 1+ right ventricular impulse with a normal left
ventricular impulse. The first heart sound (S1) was normal, but the second heart
sound (S2) was persistently split, with no variation with respiration. The pulmonary
component of S2 was mildly accentuated. A systolic crescendo-decrescendo murmur,
grade I/VI, was heard at the upper left sternal margin. No diastol ... read full excerpt from Adult Congenital Heart Disease (American Heart Association Clinical Series) ebook
