clinical features

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  • 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.
  • auscultation:
    • 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