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Atrial septal defects in adults can be missed due to other heart conditions. Advanced imaging like radioisotopic angiography is crucial for diagnosing these hidden defects.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Atrial septal defects (ASDs) are congenital heart conditions often diagnosed in childhood.
- In adults, ASDs can present atypically, complicating diagnosis.
Observation:
- Two adult patients presented with congestive heart failure and significantly elevated pulmonary blood flow (twice systemic flow).
- Classic clinical signs of ASD were notably absent in both cases.
- Both patients had coexisting hypertension and coronary artery disease.
Findings:
- Diagnosis was confirmed using right heart catheterization and radioisotopic angiography.
- These advanced diagnostic tools identified the atrial septal defect despite the lack of typical symptoms.
Implications:
- Associated conditions like hypertension, coronary artery disease, and pulmonary disease can mask ASDs in adults.
- Consider advanced imaging for unexplained congestive heart failure, even without typical ASD signs.
- Early diagnosis of masked ASDs is vital for appropriate management and preventing complications.
Abstract:
Two patients are described who presented with congestive heart failure and were found to have an atrial septal defect with a pulmonary blood flow approximately twice the systemic blood flow. Most of the usual clinical signs of atrial septal defect were absent, and the diagnosis was established by right heart catheterization and radioisotopic angiography. Both patients had hypertension and coronary artery disease. Atrial septal defect in the adult patient may not be recognized because of associated cardiac disease, including coronary artery disease and hypertension, or pulmonary disease which may obscure the usual clinical signs of a septal defect. Radioisotopic angiography and right heart catheterization should be considered in any patients with heart disease or congestive failure of obscure cause even if the usual diagnostic signs of atrial septal defect are absent.