30 Shunts
- ASD: RA and LA
- VSD: RV and LV
- PDA: PA and Ao
- nl pressure always higher in left
- result: if there's connection, usually left to right flow
VSD
- tiny hole: restrict the flow, loud murmur, asymptomatic
- large hole: not loud murmur but symptoms later in life
ASD
- major consequence: add volume to right side of heart
- increased flow across PV/TV causes systolic ejection murmur
- shun run: take samples of different chambers to see O2 sat
- ASD: step up at RA O2 sat because of blood mixing
- VSD: step at at RV
Secundum
- located in middle of wall: mid septum
Primum
- left: septum primum fusion with EDC
- right: non fusion, ASD
- seen in endocardial cushion defects, collective defects in down syndrome
PDA
- constriction of smooth muscle closes
- differential: cyanosis in lower extremities but not upper, if untreated for years
- blood drops much more during diastole to create wider pulse pressure
- tetralogy/pulmonary atresia: cyanotic baby because not enough blood to lungs
- alprostadil used to drive blood from aorta to PA
Others
- shunt: blood shunted from left to right
- very small shunting: no HF/eisenmenger
- echo: RA on left, LA on right
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