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General Reference ⬇

(Nejm 2000;342:339; Ann IM 1998;128:745)

Pathophys and Cause ⬆ ⬇

Pathophys:Left-to-right shunting from ASD, VSD, or PDA

Signs and Symptoms ⬆ ⬇

Sx:Dizziness

Si:Clubbing, cyanosis, RVH, pulmonary insufficiency murmur (Graham-Steell)

Course ⬆ ⬇

45% 25-yr survival; worsened by higher altitudes

Complications ⬆ ⬇

Thromboembolism (PE, CVA); high mortality w surgery or pregnancy; gout; gallstones; renal failure

Lab and Xray ⬆ ⬇

Lab:Echo, Holter for arrythmias

Treatment ⬆

Rx:Phlebotomy to keep crit <60%; heart-lung transplant if medical management failing