Pulmonic Stenosis

Pulmonic Area Murmur
[2nd Intercostal space on the left]
Systolic

• May be supravalvular (usually associated with other congenital anomalies, i.e.: Tetralogy, Noonan’s syndrome, etc.), valvular (almost always congenital), or subvalvular (usually seen in association with a ventricular septal defect).
• Crescendo-decrescendo murmur is the loudest in this area.
• May be associated with other murmurs common to associated congenital cardiac abnormalities.
• Murmur may be low, medium or high pitched, dependent on the severity of the gradient (moderate greater than 50 mm Hg gradient, severe greater than 80 mm Hg gradient); the later the peak of the murmur, the higher the gradient.
• Usually associated with a pulmonary ejection click.
• Murmur increases in intensity with inspiration.
• P2 may be loud.