Pulse : High volume collapsing due to the vigorous left ventricular ejection and due to the runoff into the pulmonary artery.
JVP: Prominent JVP with a-v waves are seen
Apex beat: Is forceful with cardiomegaly
Thrill: May be present in infraclavicular area
Flow mid diastolic murmur is present in mitral area.
S2: Paradoxic splitting of S2 occurs.
S3:Left ventricular S3 is present
P2 is usually soft in PDA due to masking of murmur.Split of S2 is normal in small to moderate VSD and paradoxical in large PDA.Split is normal in Eisenmenger syndrome.Paradoxical split is due to the prolonged electromechanical systole which results in delayed A2.
Continuous machinery murmur is heard in 2nd left intercostals area.
This murmur is loud in late systole and is conducted to left clavicle.
Causes PDA with early systolic murmur or absent murmur
- New born
- Preterm with respiratory distress syndrome
- PDA Eisenmenger syndrome
- Spontaneous closure.
