<prompt> Patient with VSD develops pulmonary hypertension. Which of the following will be present?Ejection systolic murmur in pulmonary areaInitial resolution of symptomsClubbingPalpable A2  <response>: Ans is B. Point to understand is that pulmonary hypertension leads to Eisenmenger syndrome but they are not the same. Cyanosis and clubbing occur in Eisenmenger reversal of shunt but not in pulmonary hypertension per se. Cause of CCF is increased pulmonary blood flow. When pulmonary hypertension develops, blood flow to lungs decreases and initial improvement in symptoms is seen. 