Rosh Internal Medicine Boost Practice Exam

In a patient with an ostium secundum atrial septal defect, which of the following is likely to be found?

1. Acute pericarditis

2. Atrial myxoma

3. Pulmonary hypertension

4. Takotsubo cardiomyopathy

The correct answer is: Pulmonary hypertension

In a patient with an ostium secundum atrial septal defect (ASD), the presence of pulmonary hypertension is commonly observed due to the chronic left-to-right shunting of blood. In this type of defect, blood flows from the left atrium into the right atrium, leading to increased blood flow to the right ventricle and subsequently to the pulmonary arteries. Over time, this increased volume can lead to elevated pressures in the pulmonary circulation. The gradual excessive blood flow and increased pressure may cause remodeling of the pulmonary arteries, contributing to the development of pulmonary vascular resistance and, eventually, pulmonary hypertension. This condition can result in symptoms like exertional dyspnea, fatigue, and right heart failure, particularly in individuals who are older and have not undergone corrective surgery. Other conditions listed, such as acute pericarditis, atrial myxoma, and Takotsubo cardiomyopathy, do not typically associate directly with an ostium secundum ASD, making pulmonary hypertension the primary complication related to this specific defect. Thus, the presence of pulmonary hypertension in this context highlights one of the significant long-term consequences of an untreated ostium secundum atrial septal defect.