Ans. is 'b' i.e., Right to left shunt o In ASD there is left to right shunt. Clinical manifestations of ASD o Patients with ASD are generally asymptomatic. o Mild effo intolerance and respiratory tract infection may occur. CHF is rare. Physical examination o Parasternal impulse Systolic thrill at 2"d left interspace. o Accentuation of S, due to loud tricuspid component. o Wide split and fixed S2. o Ejection systolic murmur at the second and third left interspaces. o Delayed diastolic murmur at the lower left sternal border. o ASD with mitral stenosis --> Lutembacher syndrome.