# Clinical Vignette **URL:** \ **Category:** MBBS\ **Tags:** medical, futuredoctors\ **Created:** [August 18, 2025, 4:36pm UTC](https://www.medboundhub.com/t/clinical-vignette/7447 "2025-08-18T16:36:04Z")\ **Posts on this page:** 12\ **Page:** 1
**Author:** ![Drgeetanjali](https://avatars.discourse-cdn.com/v4/letter/d/3e96dc/32.png) [@Drgeetanjali](https://www.medboundhub.com/u/Drgeetanjali)\ **Post date:** [August 18, 2025, 4:36pm UTC](https://www.medboundhub.com/t/clinical-vignette/7447/1 "2025-08-18T16:36:04Z")
A 21 yr old male Presents to the ER with slurred speech and right hemiparesis. On ausculataion, a systolic murmur at the pulmonic region and a diastolic rumble along the left sternal border is heard. S2 is split and fixed. What is the cause of these symptoms? 1. VSD 2. PDA 3. Aortic insufficiency 4. ASD 5. Coarctation of Aorta ---
**Author:** ![Prajal](https://yyz1.discourse-cdn.com/flex033/user_avatar/www.medboundhub.com/prajal/32/1049_2.png) [@Prajal](https://www.medboundhub.com/u/Prajal)\ **Post date:** [August 19, 2025, 4:59am UTC](https://www.medboundhub.com/t/clinical-vignette/7447/3 "2025-08-19T04:59:25Z")
I don’t know the answer looking forward tosee commmets to gain some knowledge ---
**Author:** ![Devendra528](https://avatars.discourse-cdn.com/v4/letter/d/3e96dc/32.png) [@Devendra528](https://www.medboundhub.com/u/Devendra528)\ **Post date:** [August 19, 2025, 12:19pm UTC](https://www.medboundhub.com/t/clinical-vignette/7447/4 "2025-08-19T12:19:12Z")
The fixed, wide split S₂ alongside a systolic ejection murmur and a diastolic rumble points strongly toward Atrial Septal Defect (ASD). The neurological symptoms slurred speech and right-sided weakness in a young patient likely result from a paradoxical embolism, where a clot travels through the septal defect into the arterial circulation and reaches the brain. ---
**Author:** ![Rashmi\_16](https://yyz1.discourse-cdn.com/flex033/user_avatar/www.medboundhub.com/rashmi_16/32/1030_2.png) [@Rashmi\_16](https://www.medboundhub.com/u/Rashmi_16)\ **Post date:** [August 19, 2025, 2:37pm UTC](https://www.medboundhub.com/t/clinical-vignette/7447/5 "2025-08-19T14:37:53Z")
I think ASD ---
**Author:** ![Heenakoushar](https://yyz1.discourse-cdn.com/flex033/user_avatar/www.medboundhub.com/heenakoushar/32/1297_2.png) [@Heenakoushar](https://www.medboundhub.com/u/Heenakoushar)\ **Post date:** [August 19, 2025, 2:59pm UTC](https://www.medboundhub.com/t/clinical-vignette/7447/6 "2025-08-19T14:59:09Z")
I don’t know about this ---
**Author:** ![Sushmita](https://yyz1.discourse-cdn.com/flex033/user_avatar/www.medboundhub.com/sushmita/32/946_2.png) [@Sushmita](https://www.medboundhub.com/u/Sushmita)\ **Post date:** [August 20, 2025, 5:33am UTC](https://www.medboundhub.com/t/clinical-vignette/7447/7 "2025-08-20T05:33:34Z")
No idea about this but looking for the answer in the comments. ---
**Author:** ![Kothwalzabeen](https://yyz1.discourse-cdn.com/flex033/user_avatar/www.medboundhub.com/kothwalzabeen/32/941_2.png) [@Kothwalzabeen](https://www.medboundhub.com/u/Kothwalzabeen)\ **Post date:** [August 20, 2025, 7:01am UTC](https://www.medboundhub.com/t/clinical-vignette/7447/8 "2025-08-20T07:01:55Z")
my answer is ASD. ---
**Author:** ![Drgeetanjali](https://avatars.discourse-cdn.com/v4/letter/d/3e96dc/32.png) [@Drgeetanjali](https://www.medboundhub.com/u/Drgeetanjali)\ **Post date:** [August 25, 2025, 6:54pm UTC](https://www.medboundhub.com/t/clinical-vignette/7447/9 "2025-08-25T18:54:11Z")
Absolutely correct! ---
**Author:** ![Drgeetanjali](https://avatars.discourse-cdn.com/v4/letter/d/3e96dc/32.png) [@Drgeetanjali](https://www.medboundhub.com/u/Drgeetanjali)\ **Post date:** [August 25, 2025, 6:54pm UTC](https://www.medboundhub.com/t/clinical-vignette/7447/10 "2025-08-25T18:54:22Z")
Correct! ---
**Author:** ![Drgeetanjali](https://avatars.discourse-cdn.com/v4/letter/d/3e96dc/32.png) [@Drgeetanjali](https://www.medboundhub.com/u/Drgeetanjali)\ **Post date:** [August 25, 2025, 6:55pm UTC](https://www.medboundhub.com/t/clinical-vignette/7447/11 "2025-08-25T18:55:04Z")
That’s right! ---
**Author:** ![Drgeetanjali](https://avatars.discourse-cdn.com/v4/letter/d/3e96dc/32.png) [@Drgeetanjali](https://www.medboundhub.com/u/Drgeetanjali)\ **Post date:** [August 25, 2025, 7:01pm UTC](https://www.medboundhub.com/t/clinical-vignette/7447/12 "2025-08-25T19:01:31Z")
The answer is ASD. Symptoms such as slurred speech and hemiparesis are likely due to a paradoxical embolus leading to acute embolic stroke. The embolus is paradoxical as a venous thrombus usually from the legs or pelvic region pass to the central circulation through a septal defect, mostly an ASD can sometimes be a VSD. A mid systolic murmur in ASD is due to increased flow across the pulmonic valve. A diastolic rumble is due to increased flow across the tricuspid valve. ---
**Author:** ![Param-1234](https://yyz1.discourse-cdn.com/flex033/user_avatar/www.medboundhub.com/param-1234/32/1662_2.png) [@Param-1234](https://www.medboundhub.com/u/Param-1234)\ **Post date:** [August 30, 2025, 4:21pm UTC](https://www.medboundhub.com/t/clinical-vignette/7447/13 "2025-08-30T16:21:00Z")
not have any idea about this