Differentials
Partial anomalous pulmonary venous drainage
SIGNS / SYMPTOMS
Signs and symptoms similar to interatrial communications
INVESTIGATIONS
Atrial septum intact with dilated right heart structures: identified by echocardiography in children, and MRI or CT in adults.
Ventricular septal defect
SIGNS / SYMPTOMS
Small ventricular septal defects (VSDs) are associated with a holosystolic murmur and normal first and second heart sounds. With a larger shunt volume (ratio of pulmonary vascular to systemic blood flow, Qp:Qs, >2), a mid-diastolic mitral valve flow murmur may be heard in addition to a holosystolic mid-frequency murmur.
INVESTIGATIONS
VSD identified by Doppler echocardiography.
Patent ductus arteriosus
SIGNS / SYMPTOMS
Associated with prematurity. Associated with bounding peripheral pulses due to wide pulse pressure. The left ventricular impulse may be prominent. The murmur associated with a patent ductus arteriosus (PDA) is often described as a machinery-like continuous murmur. However, in some premature and newborn infants the murmur can be heard only in systole. A mid-diastolic mitral valve flow murmur may be heard.
INVESTIGATIONS
PDA identified by Doppler echocardiography.
Pulmonary stenosis
SIGNS / SYMPTOMS
A click follows the first heart sound, which is best heard at the left upper sternal border.
The second heart sound may be normal, split, or single depending on the severity of the stenosis.
INVESTIGATIONS
Pulmonary stenosis identified by Doppler echocardiography.
Right bundle-branch block
SIGNS / SYMPTOMS
Can produce a widely split second heart sound similar to that heard in patients with an interatrial communication.
The characteristic murmurs are absent.
INVESTIGATIONS
ECG shows right bundle-branch block.
Echocardiography shows no evidence of an interatrial communication.
Other congenital heart defects
SIGNS / SYMPTOMS
Interatrial communications occur in the context of other congenital heart conditions, including transposition of the great arteries, pulmonary atresia, and Ebstein anomaly.
INVESTIGATIONS
Abnormal anatomy identified by Doppler echocardiography.
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