Understanding ASD and ECG

Introduction

Atrial Septal Defect (ASD) is a congenital heart defect where there is an abnormal opening in the atrial septum (the wall that separates the left and right atria). This opening allows oxygenated and deoxygenated blood to mix, which can lead to complications such as heart failure, arrhythmias, or pulmonary hypertension if left untreated.

Types of ASD:

  1. Ostium Secundum ASD – Most common type, located in the middle of the atrial septum.
  2. Ostium Primum ASD – A more severe form, often associated with other congenital defects.
  3. Sinus Venosus ASD – Located near the veins that bring blood to the heart.
  4. Coronary Sinus ASD – Rare, involves the coronary sinus.

How ECG Helps in Diagnosing ASD

An Electrocardiogram (ECG or EKG) is a non-invasive test measuring the electrical activity of the heart. In ASD, ECG findings may include: - Right bundle branch block (RBBB) – Due to the enlargement of the right ventricle. - Right axis deviation – More common in larger defects. - Atrial arrhythmias – Such as atrial fibrillation or atrial flutter in older patients. - Prolonged PR interval – Sometimes seen due to abnormal conduction within the atria.

How is ASD Treated?

  1. Small ASDs may close on their own over time and may not require treatment.
  2. Moderate to large ASDs often require closure using:
    • Catheter-based procedures (for secundum ASD).
    • Surgical repair (for larger or more complex ASDs).

Why Early Detection Matters

If left untreated, ASD can lead to: - Stroke due to paradoxical embolism. - Pulmonary hypertension from increased blood flow to the lungs. - Right heart failure over time. Thus, early detection through ECG and echocardiography is crucial for timely treatment.

Source recommendations

1. American Heart Association Guidelines for the Management of Adults with Congenital Heart Disease

  1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000603
  2. https://pubmed.ncbi.nlm.nih.gov/30121240/
  3. https://www.jacc.org/doi/10.1016/j.jacc.2021.09.010
  4. https://pubmed.ncbi.nlm.nih.gov/30586767/
  5. https://www.heart.org/en/health-topics/congenital-heart-defects

2. European Society of Cardiology Guidelines for the Management of Grown-Up Congenital Heart Disease

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Grown-Up-Congenital-Heart-Disease-Management-of
  2. https://academic.oup.com/eurheartj/article/42/6/563/5898606
  3. https://pubmed.ncbi.nlm.nih.gov/20801927/
  4. https://www.jacc.org/doi/10.1016/j.jacc.2021.09.010
  5. https://pubmed.ncbi.nlm.nih.gov/32860028/

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