Page 100 - Clinical Pearls in Cardiology

88 Clinical Pearls in Cardiology

shunt (i.e. during inspiration, the venous return to
right side of heart increases but the left-to-right
shunting of blood through the ASD decreases. During
expiration, the venous return decreases but the left-
to-right shunt increases). Thus both the inspiratory
and expiratory right ventricular stroke volumes
always remain constant (Fig. 5).

Fig. 5: Reciprocal relationship between shunt and
venous return in ASD

6. How will you auscultate for the fixed splitting of second
heart sound?
Apparent fixed splitting of the second heart sound may
be occasionally present in young normal individuals.