Step I Eisenmenger Complex

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IandIatrogenic

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10+ Year Member
A quick question about reversal of shunts.

Is an Eisenmenger Complex strictly the reversal of a ventricular left to right shunt or can the late manifestation an atrial left to right shunt reversal secondary to volume overload from pulmonary hypertension in a persistent ostium primum be considered an eisenmenger complex as well? Thanks.
 
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IandIatrogenic said:
A quick question about reversal of shunts.

Is an Eisenmenger Complex strictly the reversal of a ventricular left to right shunt or can the late manifestation an atrial left to right shunt reversal secondary to volume overload from pulmonary hypertension in a persistent ostium primum be considered an eisenmenger complex as well? Thanks.
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FA pg 267: "uncorrected VSD, ASD or PDA..."
 
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Think about physics, fluid dynamics, sound and the location of the left atrium and then tell me what ascultation of at the PMI (apex) has to do with best listening to mitral regurgitation.

Two factors dictate where one listens to a heart sound
1). the direction of the turbulent flow
2). the anatomic location of the heart in relation to the chest well

From what I understand MR is best listening to near the Anterior axillary line at the 3rd intercostal space.

Of course after just having looked it in braunwald's I am disappointed to see that they also repeat this fallacy but with due respect to it as resource it is probably best to answer 5th ICS at the MCL. I can't say I have any 1st hand experience that leads me to conclude that braunwald's is incorrect but this was what a cardiologist taught our class and the physiology and physics behind this explanation makes more sense.
 
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IandIatrogenic said:
Think about physics, fluid dynamics, sound and the location of the left atrium and then tell me what ascultation of at the PMI (apex) has to do with best listening to mitral regurgitation.

Two factors dictate where one listens to a heart sound
1). the direction of the turbulent flow
2). the anatomic location of the heart in relation to the chest well

From what I understand MR is best listening to near the Anterior axillary line at the 3rd intercostal space.
Click to expand...

I'm pretty sure Bates' and Cecil's would have corrected that years ago if it were how it worked clinically. But your reasoning makes sense.
 
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I agree, the reasoning does make sense, but I believe that, for whatever reason, murmurs are best heard downstream of the valve pathology even if the regurgitation is going "upstream." It's never made sense to me either, but I think aortic regurg is also heard best at the left sternal border rather than over the LV.
 
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