<prompt> Wide and fixed 2nd heart sound seen in -ASDVSDAortic stenosisPDA  <response>: A ASD 632. Davidson 21st 1922 - 24 - H 19thAtrial septal defect Wide fixed splitting of the second heart sound wide because of delay in right ventricular ejection increased stroke volume and right bundle branch block and fixed because the septal defect equalizes left and right atrial pressures throughout the respiratory cycle. A systolic flow murmur over the pulmonary valve. ECG - incomplete RBBB right bundle branch blackVENTRICULAR SEPTAL DEFECT: Pansystolic murmur usually heard best at the left sternal edge but radiating all over the precardium. A small defect often produces a loud murmur maladie-de-Roger in the absence of other haemodynamic disturbances. Most congenital defects are perimembranous i.e. at the junction of the membranous and muscular portions. ECG shows bilateral ventricular hypertrophy.TETRALOGY OF FALLOT: Cyanosis with a loud ejection systolic murmur in the pulmonary area ECG right ventricular hypertrophy X-ray chest boot shaped heartPATENT DUCTUS ARTERIOSUS: A continuous machinery murmur is heard with late systolic accentuation, maximal in the second left intercostals space below the clavicle. It is frequently accompanied by a thrill, pulse are increased in volume. ECG is usually normalAORTIC STENOSIS:A harsh ejection systolic murmur radiates to the neck with a soft second heart sound particularly in those with calcific valve, low pitched, rough and rasping in character.The murmur is often likened to a saw cutting wood and may especially in older patients have a musical quality like the new of a seagull. Slow rising carotid pulse, narrow pulse pressure. Thrusting apex beat LV pressure overload Sign of pulmonary venous congestion e.g. crepitations,ECG - LV hypertrophy, ST - segment depression and T. wave inversion LV - strainLutembachers syndrome consist of - ASD and MS 