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cardiac right to left shunt

See congenital heart disease Etiology: 1) patent foramen ovale (38%) 2) pulmonary arteriovenous malformation (28%) 3) 5% with both 4) Eisenmenger's syndrome 5) No association of shunting with migraine Epidemiology: - 71% of healthy volunteers have some right-to-left shunting - shunt size mostly 'small to moderate' Laboratory: - complete blood count: erythrocytosis - pulse oximetry or arterial blood gas: hypoxia Special laboratory: - echocardiogram: - identified by saline contrast echocardiogram (bubble study) Management: - consider air filters on intravenous lines in hospitalized patients to prevent paradoxical air embolism [2]

General

cardiac shunt

References

  1. Woods TD et al. Small- and moderate-size right-to-left shunts identified by saline contrast echocardiography are normal and unrelated to migraine headache. Chest 2010 Aug; 138:264. PMID: 20154080
  2. Medical Knowledge Self Assessment Program (MKSAP) 16, 17 American College of Physicians, Philadelphia 2012, 2015