L To R Shunt

Question 1

VSD

Answer 1

May remain asymptomatic

Large: LV overload / HF

Question 2

ASD

Answer 2

Wide and fixed S2 splitting 
Symptom: none to HF
Missing septal tissue (foramen ovale: unfused septal tissue) 
Lead to paradoxical amboli
Associated with Down syndrome

Question 3

PDA

Answer 3

Progressive RVH/ LVH/HF
Continious machine like murmur
Patency is maintained by PGE and low O2
End by indomethacin
Differential cyanosis : lower extremities

Question 4

Eisenmenger

Answer 4

Uncorrected shut vsd asd pda
Pulmonary arterial HTN

To compensate: RVH: shunt becomes r to l
Late cyanosis : clubbing and polycythemia