Study note
MedicineCardiology

Clinical examination in pulmonary stenosis

THE CONTEXT
Pulmonary stenosis produces characteristic auscultatory findings, with additional signs in severe disease.

Murmur and associated sounds

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The principal finding is an ejection systolic murmur, loudest at the left upper sternum and radiating towards the left shoulder.
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A thrill may be present and is best felt when the patient leans forwards and breathes out.
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An ejection sound or click often precedes the murmur.
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Delayed right ventricular ejection may cause wide splitting of the second heart sound.

Features of severe stenosis

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Severe pulmonary stenosis produces a loud, harsh murmur and an inaudible pulmonary closure sound, P2.
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An increased right ventricular heave and prominent a waves in the jugular pulse are additional features of severe disease.
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