> For the complete documentation index, see [llms.txt](https://thisispiggy.gitbook.io/my-wiki/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://thisispiggy.gitbook.io/my-wiki/01-step-1/cardiology/30-shunts.md).

# 30 Shunts

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/different%20types%20of%20left%20to%20right%20shunts/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/BKxZVnK.jpg)

* ASD: RA and LA
* VSD: RV and LV 
* PDA: PA and Ao

![](https://f001.backblazeb2.com/file/wikiFiles/OUT2oOQ.jpg)

* nl pressure always higher in left
* result: if there's connection, usually left to right flow

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/left%20to%20right%20shunt%20at%20birth%20and%20years%20later/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/4QK0oCU.jpg)

* no cyanosis at birth

![](https://f001.backblazeb2.com/file/wikiFiles/a9xt7hv.jpg)

* epo release

## VSD

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/VSD%20shunt%20murmur,%20small%20vs%20large/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/pNkQwEQ.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/flPmXhr.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/PdHybpJ.jpg)

* tiny hole: restrict the flow, loud murmur, asymptomatic
* large hole: not loud murmur but symptoms later in life

## ASD

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/ASD%20shunt%20murmur,%20Shunt%20run%20is.%202%20types)..

![](https://f001.backblazeb2.com/file/wikiFiles/0wCLGTs.jpg)

* major consequence: add volume to right side of heart
* increased flow across PV/TV causes systolic ejection murmur

![](https://f001.backblazeb2.com/file/wikiFiles/uG38l7U.jpg)

* 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

![](https://f001.backblazeb2.com/file/wikiFiles/1x0NPqW.jpg)

* located in middle of wall: mid septum

![](https://f001.backblazeb2.com/file/wikiFiles/3vomYgI.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/o6tyJva.jpg)

### Primum

![](https://f001.backblazeb2.com/file/wikiFiles/NSDoaPO.jpg)

* left: septum primum fusion with EDC
* right: non fusion, ASD
* seen in endocardial cushion defects, collective defects in down syndrome

![](https://f001.backblazeb2.com/file/wikiFiles/iqkWm8w.jpg)

* hole located lower

## PDA

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/PDA%20is,%20cause,%20murmur,%20acute%20vs%20years,%20keep%20open%20and%20closed%20drug/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/UED4y3v.jpg)

* constriction of smooth muscle closes

![](https://f001.backblazeb2.com/file/wikiFiles/QvRRBaI.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/4PvZFWO.jpg)

* differential: cyanosis in lower extremities but not upper, if untreated for years

![](https://f001.backblazeb2.com/file/wikiFiles/cp5B0ti.jpg)

* blood drops much more during diastole to create wider pulse pressure

![](https://f001.backblazeb2.com/file/wikiFiles/FaKzDH7.jpg)

* tetralogy/pulmonary atresia: cyanotic baby because not enough blood to lungs
* alprostadil used to drive blood from aorta to PA

![](https://f001.backblazeb2.com/file/wikiFiles/o0nQrBY.jpg)

## Others

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/what%20is%20Qp%20Qs%20ratio/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/loY77fa.jpg)

* shunt: blood shunted from left to right

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/fetal%20alcohol%20syndrome%20and%20congenital%20heart%20defect/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/zsT0Eth.jpg)

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/PFO%20is,%20symptoms,%20complication/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/Ttg60oa.jpg)

* very small shunting: no HF/eisenmenger
* echo: RA on left, LA on right