A 20-year-old man comes to the office due to occasional palpitations. He describes them as "skipped beats." He has no chest pain or shortness of breath. Medical history is unremarkable. On physical examination, he has wide, fixed splitting of the second heart sound (S2). No murmurs are heard. Chest x-ray reveals enlargement of the right heart contour. Echocardiogram is consistent with a congenital heart defect. Repair of this patient's congenital disease is aimed at preventing irreversible changes to which of the following?

Question

A 20-year-old man comes to the office due to occasional palpitations.  He describes them as "skipped beats."  He has no chest pain or shortness of breath.  Medical history is unremarkable.  On physical examination, he has wide, fixed splitting of the second heart sound (S2).  No murmurs are heard.  Chest x-ray reveals enlargement of the right heart contour.  Echocardiogram is consistent with a congenital heart defect.  Repair of this patient's congenital disease is aimed at preventing irreversible changes to which of the following?

Quizplus · Accepted Answer

Eductional Objective: Atrial septal defects cause wide, fixed splitting of the second heart sound due to right-sided volume overload from left-to-right shunting.  Uncorrected defects can lead to irreversible medial hypertrophy of the pulmonary arteries with pulmonary hypertension and reversal to right-to-left shunting (ie, Eisenmenger syndrome).

A 20-Year-Old Man Comes to the Office Due to Occasional