What is the effect of PAH on physical signs of ASD ?

When the person with ASD develop PAH. The following effects are noticed.

Prominent a wave is present in JVP.

Split of S2 narrows.

Two new sounds appear they are pulmonary ejection click (PEC) and right ventricular S4 (RVS4)

Two murmur disappeares they are pulmonary ejection systolic murmur and tricuspid mid diastolic murmur.

Two new murmurs appear 

• Tricuspid pansystolic murmur
• Pulmonary early diastolic murmur

Usually with fixed split of S2 narrows with ASD with PAH, but when ASD with PAH is in RV failure (Right ventricular) wide fixed split is retained.

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