We describe a woman who presented in her third trimester of pregnancy with progressive dyspnea. Physical exam showed a hyperdynamic right ventricular impulse and a widely split fixed S2. Echocardiography showed moderately enlarged right sided chambers and linear insertion of the atrioventricular valves. This echocardiographic finding is typically consistent with a partial atrioventricular septal defect (AVSD). However further imaging with cardiac MRI revealed a large ostium secundum atrial septal defect (ASD), with a pulmonary to-systemic flow ratio of 2.4. This appears to be the first documented case in the literature of a secundum ASD presenting with linear insertion of the atrioventricular valves. In conclusion, we describe an unusual case of secundum atrial septal defect in pregnancy presenting with dyspnea and linear insertion of the atrioventricular valves.

Cardiovascular Disease (CVD) is the leading cause of death globally in women and men, respectively 34.6% and 31.4% in 2019. The incidence of CVD is higher in men, yet worse prognosis and higher mortality after an acute cardiovascular event are seen in women. Advances in diagnosis and treatment have led to a reduction in mortality rates in both sexes over the last decades.

Background: Atrial Fibrillation (AF), the most common sustained cardiac arrhythmia, significantly increases the risk of stroke, heart failure, and mortality. Hypertension (HTN) is a leading risk factor for AF, with hypertensive heart disease being the most common underlying disorder in AF patients. Despite the global rise in AF prevalence, data on its burden and correlates among hypertensive patients in Sudan remain limited. This study aimed to assess the burden and correlates of AF among hypertensive patients attending Al Mek Nimr University Hospital in 2024.

Materials and Methods: A descriptive cross-sectional study was conducted from July to December 2024, enrolling 133 hypertensive patients. Participants were selected using a consecutive sampling technique, with a sample size calculated at a 95% confidence level and a 5% margin of error, assuming an AF prevalence of 10%. Data were collected through structured questionnaires administered via direct interviews. The questionnaire included demographic information, hypertension history, clinical symptoms, comorbidities, and medication use. AF diagnosis was confirmed through ECG and/or medical records. Data were analyzed using SPSS version 25.0, with descriptive statistics, Chi-square tests, and t-tests used to assess associations.

Results: The prevalence of AF among hypertensive patients was 19.5%, with higher rates observed in older adults (37.5% in patients > 75 years) and women (23.2%). Common symptoms of AF included easy fatigue (65.4%) and palpitations (50.0%) (P = 0.018). Additionally, 46.2% of AF patients reported a history of stroke (P = 0.002), and 42.3% reported loss of independence in performing daily activities (P = 0.039), reflecting the significant burden of AF in this population. Comorbidities such as diabetes (34.6%) and obesity (26.9%) were present among AF patients but did not show statistically significant associations. Although 65.4% of AF patients were on anticoagulants, a notable proportion (34.6%) remained untreated, likely due to recent diagnosis, acute stroke presentation, or contraindications, highlighting a gap in thromboembolic risk management. Diuretics were more commonly used in AF patients (38.5%) compared to non-AF patients (P = 0.003), while the use of RAAS inhibitors (ACEIs and ARBs) was low (10.5% and 35.3%, respectively).

Conclusion: This study highlights the high burden of AF among hypertensive patients, especially in older individuals. The strong associations with stroke and functional decline underscore the need for systematic AF screening, optimized anticoagulation, and increased use of RAAS inhibitors in this high-risk population.