Atrial Fibrillation and Shortness of Breath



Atrial Fibrillation and Shortness of Breath





A 42-year-old woman had her first episode of atrial fibrillation 3 years ago. Over the last year, she developed symptoms of fatigue and shortness of breath.

Physical examination showed no signs of cardiac decompensation. On auscultation, a split second heart sound was noted.

See Figures 24-1, 24-2 and 24-3 and Videos 24-1 and 24-2.






Figure 24-1. M-mode, parasternal long-axis view.






Figure 24-2. A. Conventional 2D transesophageal echocardiogram (TEE) with color Doppler in different planes at 0°. B. Conventional 2D TEE with color Doppler at 30°.






Figure 24-3. Conventional 2D TEE with and without color Doppler at 110°.



QUESTION 1. What is the diagnosis?


A. Ventricular septal defect

B. Secundum atrial septal defect

C. Atrioventricular (AV) canal defect

D. Left-to-right shunting through a stretched patent foramen ovale

View Answer

ANSWER 1: B. The short-axis view (Fig. 24-2 and Video 24-1) at 30° shows that the patient had no aortic rim, and the long-axis view (Fig. 24-3 and Video 24-2) at 110° documents two atrial septal defects in the secundum portion of the atrial septum.






Figure 24-2. A. Conventional 2D transesophageal echocardiogram (TEE) with color Doppler in different planes at 0°. B. Conventional 2D TEE with color Doppler at 30°.






Figure 24-3. Conventional 2D TEE with and without color Doppler at 110°.




QUESTION 2. How would you proceed?


A. The patient has only mild symptoms; a routine follow-up in 6 months is sufficient

B. Closure of the atrial septal defects (surgery or transcatheter closure)

View Answer

ANSWER 2: B. Indications for atrial septal defect closure include symptoms and/or right ventricular/right atrial enlargement and/or a pulmonic blood flow: Systemic blood flow > 1.5 and/or paradoxical embolism.1

The patient has symptoms, and the M-mode (Fig. 24-1) shows right ventricular enlargement.






Figure 24-1. M-mode, parasternal long-axis view.

Therefore, treatment is indicated, and it was decided to close the defect with percutaneous closure devices.

The procedural steps are shown in Figures 24-4, 24-5 and 24-6 and Video 24-3.

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Jul 15, 2016 | Posted by in CARDIOLOGY | Comments Off on Atrial Fibrillation and Shortness of Breath

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