- usually asymptomatic, presenting only with a murmur.
- if severe obstruction, the cardiac output may be reduced and exertional syncope occasionally can result.
- longstanding obstruction may result in right ventricular failure and therefore necessitate a high filling pressure - right atrial pressure.
- patient appears normal unless there is a recognisable syndrome in association.
- pulse and blood pressure are normal.
- JVP - a large a wave signifies atrial hypertrophy.
- may be a parasternal heave due to right ventricular hypertrophy - and maybe a thrill in the pulmonary area.
- pulmonary ejection click - the click disappears on inspiration in severe stenosis.
- a loud pulmonary ejection murmur - loudest to left of upper sternum, with radiation to the left shoulder.
- second heart sound - with significant obstruction the P2 is delayed and soft.
Last reviewed 01/2018