cardiovascular disorders
Pulmonic Stenosis
Key Points
Pulmonic stenosis is usually congenital, but symptoms (eg, syncope, angina, dyspnea) usually do not appear until adulthood. Heart sounds include increased splitting of the second heart sound and a harsh crescendo-decrescendo ejection murmur heard best at the left parasternal second or fourth intercostal space when the patient leans forward; the murmur grows louder immediately with Valsalva release and with inspiration. Balloon valvuloplasty is done for symptomatic patients and for asymptomatic patients with normal systolic function and a peak gradient>40 to 50 mm Hg. 