All are signs of impending Eisenmenger except –
Increased flow murmur across tricuspid & pulmonary valve
Single S2
Loud P2
Graham steel murmur
Eisenmenger syndrome refers to patients with a VSD in which blood is shunted from right to left as a result of development of pulmonary vascular resistance. Initially shunt is from left to right as the systemic vascular pressure is greater than pulmonary vascular pressure. With time pulmonary vascular resistance increases due to change in pulmonary vessel wall as a result of increased flow in pulmonary vessels. When pulmonary vascular pressure exceeds the systemic vascular resistance, reversal of shunt into right to left shunt occurs.
This development of right to left shunt due to reversal of left to right shunt as a result of development of pulmonary vascular resistance and pulmonary hypertension is called Eisenmenger syndrome.