Sir the way you teach and kind of make it like an inner monologue is awesome, as well as how you frame the concept around how it's asked in in the test is so helpful. thank you for this video!!
finally ... you are back , sir ! Good to see you again :) Keep up the good work and please try to avoid taking such long breaks ( 2 years ). i love your explanations. Thank you :)
Hey Bob! Sorry for the long break, I was focusing on finishing up my residency. But I'm back and better than ever! Thanks for your support, there are plenty more to come.
Hello, Isnt the pressure in the Left Atrium higher than in the Right Atrium so wouldnt the embolism have a harder time crossing over and cause a brain stroke? After all an ASD is a Left to Right shunt?
NO...actually failure of the septum secundum and septum primum to fuse after birth is going to result in a patent foramen ovale which is going to maintain that right to left shunt so if this condition goes untreated it can further result in the paradoxical embolism as he is explaining.
a paradoxical embolism can occur even in patients with net left-to-right shunting due to transient reversal of the shunt during periods of elevated right-sided pressure (eg, early ventricular systole, straining during coughing or defecation). - uw
I wonder if this is PFO rather than an ASD. In PFO you have increased pressure in the RA which would cause a right to left shunt and a stroke from a DVT. Would you not have high pressure in the LA in an ASD and a left to right shunt? And in case it was a PFO, the answer would be a faint systolic murmur. For ASD like you mentioned either fixed split S2 +/- ejection systolic murmur
