Аудіо 00063. Large ASD

This girl who was previously considered healthy was found to have a murmur during with an infection. She probably sleeps more than usual and does not like to run. This slender girl has a prominent right ventricle. On auscultation a third-degree coarse pansystolic murmur is heard, second heart sound is late, and when lying down a diastolic murmur is heard at the apex. ECG shows a partial RBBB, the axis deviates to the right, right atrial loading and long PQ time. Chest radiograph shows a large heart (550 mL/m2) and engorged pulmonary vasculature. Echocardiography shows large secundum-type ASD. The ASD murmur is caused by increased pulmonary artery flow that resembles physiological pulmonary flow when the defect is minor and pulmonary stenosis when the defect is larger. Both the phonogram and the spectrogram show the delay of P2 without respiratory variation. This auscultation area does not reveal the diastolic murmur, nor is it seen on the phonogram. Age 4.9 years, height 105.0 cm weight 15.0 kg. Area of auscultation left second ic (LIC2).