Answer :USMLE step 2 Mcq 343:A 50-year-old woman has a history of an assymptomatic atrial septal defect




Correct Answer: B

This woman has developed massive irreversible pulmonary hypertension as a consequence of a previous left to right shunt. Pulmonary pressures have now reached systemic level. The reversal of a left to right shunt as a consequence of pulmonary hypertension is known as Eisenmenger’s syndrome, and is generally the result of a previously undiagnosed ASD, ventricular septal defect (VSD) or patent ductus arteriosus. It may also result from an incompletely corrected Fallot’s tetralogy or Ebstein’s anomaly. Prognosis is poor, although a few patients may be candidates for heart–lung transplantation. Symptomatic treatment is directed towards right heart failure. Complications include polycythaemia, bleeding disorders and cerebral embolism or abscess. Since there is a particularly high risk in those of childbearing age, patients should be given appropriate advice and information to avoid pregnancy


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